Want to know if you suffer from AF? There's an app for that!
Breaking news: a pool of researchers recently managed to develop a smartphone-based application allowing patients to detect an irregular, AF-derived pulse. The two algorithms developed for the app successfully distinguished AF from sinus rhythm.
"Many of our patients have symptomatic atrial fibrillation," said lead investigator Dr David McManus (University of Massachusetts Medical School, Worchester, MA). "It motivates them to keep track of their episodes. But nowadays everybody owns a smartphone: so why don't we use it to capture the pulse while the AF-event is occurring, rather than keep on using monitors?"
The application uses the smartphone camera and the flash to illuminate the fingertip when it is placed on top of the camera surface. The flash lens then illuminates the finger as the camera records in real time the changes in the colour of the fingertip. The changes in colour represent blood flow, and they're processed by a software embedded within the smartphone.
"As for this study, patients need to keep their fingertip on the camera for at least one minute," says McManus. In the study, 76 adults with persistent AF - all scheduled to undergo elective cardioversion - were included in the analysis. All those among them who had a preprocedure ECG placed their finger on an iPhone 4S camera, for a period between one and two minutes, while the program ran. Following cardioversion, those patients who were converted to normal sinus rhythm again reapplied their finger to the smartphone, in order to obtain another recording.
The algorithms showed great sensitivity (0.962), specificity (0.975) and accuracy (0.968) for the discrimination of an irregular pulse during atrial fibrillation from sinus rhythm.
As a prove of the outstanding scientific value of this study, its results were eventually published online by Heart Rhythm, on December 7, 2012, and are currently waiting for publication in the Heart Rhythm Journal, too.
"While in hospital, and trained by a coach to use the application, people proved to use the app successfully, and soon know if they were in or out of atrial fibrillation," reports McManus.
Patients with diagnosed and treated atrial fibrillation, who want to have as complete control as possible on the episodes they are having, may not want to go to the hospital or visit their doctor at every suspect of AF. "They want something accurate but quick, and easy to use: moreover, a tool like this is really important for a better communication with their doctor," continues McManus.
Well, yes indeed: the app enables users to e-mail results directly to their physician, and also provides summaries of atrial-fibrillation burden over selected periods: the next issue will be that of the application fitting into traditional testing procedures - and of course its costs, too.
But McManus concentrates on the positive effects: "Patients - young and old - just needed it. I've been through several clinical studies, but never saw such an enthusiastic participation from patients as I did in this one: they just said it was really cool!"
Atrial fibrillation: 4 out of 10 Italians don’t know it, 6 out of 10 ignore its link with stroke
CENSIS has recently presented the results of the first survey on the knowledge of atrial fibrillation in our country in Rome.
Results are quite worrying: over 40% of people suffering from AF don't exactly know what this disease is about. It's time to start building an information strategy aiming at preventing the pathologies derived from this disease for good.
The survey, called “Atrial fibrillation: spreading knowledge and improving the cure", has proved AF to be the most common heart rhythm disease, with 850.000 people suffering from it in Italy alone.
The research analyzed three different groups: 1.000 citizens all over Italy, 300 general practitioners and 1.200 patients with AF.
General data are quite astonishing: 36,5% of the citizens don't know what AF is, while 28,5% of them have heard something about it, but can't exactly tell what it is about.
Awareness about the risk of stroke linked with this disease is very poor: 1 out of 6 Italians don't know that AF implies a fivefold increase of the risk of stroke, with a devastating impact on the single individual's health conditions.
In Italy alone, 40.000 people suffer from both these pathologies: a diffusion index which is constantly growing, since forecasts show that the number of AF cases is bound to nearly double in 2050 - and we can only guess what that will mean in terms of collective health and healthcare expenses.
But where do citizens go to get further information on AF? Well, they generally ask their own general practitioners (73%) - it follows that these healthcare professionals' role is a key one, as is their commitment in treating AF by using oral anticoagulants. The procedure also involves specialists, mainly in the first phase of the therapy, whose follow-up is eventually carried on through the work of general practitioners.
A hard job to be done, since standard AF-patients don't know much about the disease they're suffering from.
About 55% of patients consider AF quite a severe pathology, while 33% of them consider it a very severe one - but 10,9% of them think it's not that severe, and 0,7% of them think that it doesn't imply any risk for their health.
“Institutions and scientific community have to come together in order to combat this disease," claimed Sen. Antonio Tomassini, President of the XII Hygiene and Health Commission of the Italian Republic Senate and President of the Parliamentary Association for the safeguard and protection of the right to prevention. "Several social subjects are ready and willing to operate in order to face this increasingly widespread phenomenon."
“Italy is almost facing a national emergency on atrial fibrillation," said Prof. Gian Franco Gensini, Head of the Medicine and Surgery Institute at the University of Florence, one of the many renowned experts who gave their contribution to the survey. “This research and the following document which has been presented to the Senate reflect a synergic approach to be used in future strategies to combat AF”.
Censis - with the contribution by Boehringer Ingelheim - has first investigated the citizens' general perception of this pathology through a questionnaire, then reviewed the single patients' conditions in separated interviews.
“AF is generally unrecognized and underrated," said Dr. Ketty Vaccaro, Responsible for Welfare at Censis. “Ours is a very important work, both from the healthcare and from the social point of view: it does exist a sort of informative void which necessarily has to be filled, and that through institutions, healthcare professionals and everyone involved in fighting this disease. We must not forget that AF will have a highly devastating impact in the near future, because of the progressive aging of population."
Highly-detailed information, but also advice on risk factors and patients' needs. "The results prove that it isn't possible to postpone the general availability of the several therapeutic options in our country anymore," concluded Dr. Tonino Aceti, Responsible for the National Coordination of the Associations of the Chronically Sick of Cittadinanzattiva.
Is Europe really on the brink of a stroke crisis?
The “How Can We Avoid a Stroke Crisis in Europe?” report, published on the occasion of last October's World Stroke Day, by Action for Stroke Prevention (ASP), alarmingly highlights that the first time many people will find out they suffer from AF is when they have a stroke. But that's not all: according to the report, 70% of patients with known AF who had a stroke were not receiving anticoagulant therapy at the time.
With increasingly stretched healthcare budgets all over the Old Continent, and with the annual cost of stroke reaching € 64 billion in Europe, more needs definitely to be done to reduce the number of these tragic events.
That's why, in addition to the above mentioned report, ASP has also launched two other documents, aimed at healthcare decision makers and healthcare professionals respectively, both providing concrete suggestions for steps to be taken to reduce the personal and economic impact of AF-related stroke.
“AF must be recognized as a serious risk factor for stroke in national prevention plans, and concrete actions must be defined in these plans to strongly and effectively support earlier diagnosis and improve awareness, education and prevention,” said John Camm, Professor of Clinical Cardiology at St George’s University, London, UK. “We invite national governments to act in conformity of United Nations’ commitment to reduce the so-called non-communicable diseases by 25% by the year 2025.”
A hard challenge for many parties - healthcare professionals, policy-makers, medical societies, patient groups and industry, too – and a strong invitation to work together to reduce the unsustainable burden of AF-related stroke.
The report's key recommendations include:
- improving public awareness and understanding of AF
- implementing practice standards for healthcare professionals;
- facilitating the exchange of best practices between Member States
As we all know, KNOWLEDGE is the keyword: according to a recent European survey, nearly a third (31%) of people fear having a stroke above some other serious health conditions - such as heart disease and diabetes - but 52% of people in Europe have never heard of AF. More worryingly, 85% of people in Europe do not know that AF is a serious risk factor for stroke: 65% of Europeans identify high blood pressure as a key stroke risk factor, but only 15% know that AF is a risk factor for stroke, despite AF increasing the risk of stroke much more than high blood pressure.
“Awareness and management of AF are very poor" says Eve Knight, Chief Executive and Co-Founder of the charity AntiCoagulation Europe. “People need to be diagnosed prior to a stroke and have easier access to treatment, or the situation will only get worse as the number of people with AF is predicted to vastly increase.”
Tellingly, despite the availability of clinical practice guidelines on AF - such as the ESC Guidelines - adherence to them is still very poor, and there seems to be an under-use of effective stroke prevention therapies in AF: several studies report anticoagulant use in less than 50% of people with AF who are at high risk of stroke - and that's not a particularly high percentage...
But let's have a look at a wider audience: only 16% of the general public worldwide are aware that the risk of AF-related stroke can be reduced with anticoagulant treatment - it follows that the need for education to enable patients to participate in their own healthcare decisions is a serious international issue.
Europe moves on by approving apixaban in stroke prevention - while Italy is left standing
The use of apixaban has finally been approved by EMA (European Medicines Agency): that's what Bristol-Myers Squibb and Pfizer, the two companies which jointly developed the product, have recently announced. A great step ahead towards the use of this drug in stroke and systemic embolism prevention in patients affected by non-valvular atrial fibrillation with one or more risk factors.
EMA's approval is the necessary condition for the introduction of apixaban in Italy as well - but the new oral anticoagulant will also have to be approved by AIFA (Italian Drug Agency).
At the moment, no new oral anticoagulant for the prevention of thromboembolic risk in patients suffering from AF has been approved in Italy yet. Even dabigatran and rivaroxaban - which have already been authorized by EMA and FDA (Food and Drug Administration - are still waiting for approval our country.
A guilty delay, causing Italy to be one of the few countries where these drugs still can't be prescribed for reducing stroke in patients with AF - a gap that must be plugged as soon as possible, since the new drugs represent an effective improvement compared to those still used in Italy.
Apixaban has been showing a higher stroke risk, systemic embolism, major bleeding and mortality reduction than warfarin in many controlled and randomized clinical trials. This drug - like all the new oral anticoagulants - doesn't need any monitoring activity by INR (International Normalized Ratio), and any diet restriction, too.
”We all know that patients suffering from atrial fibrillation have a fivefold-higher stroke risk: the Public Health System's request for more effective treatment options should come as no surprise" says Lars Wallentin, Cardiology Director and Professor at the Uppsala Clinical Research Centre and University Hospital in Sweden. “The recent approval of apixaban is a milestone for all the healthcare professionals, who now have an oral anticoagulant with higher results than warfarin in the reduction of stroke risk in patients with non-valvular atrial fibrillation".
Just how long will we have to wait for apixaban to be approved in Italy, too? It would really be a key tool in contrasting AF-related strokes, which are notoriously the most disabling ones.
New oral anticoagulants: a key tool to fight AF-related stroke
AIPA (the Italian Anticoagulants Patients Association) has recently celebrated its 25th anniversary in Padua - the event hosted many representatives from the scientific world and from the institutions, too. The meeting provided a precious occasion to analyze the great advantages of the "second generation"-oral anticoagulants - and that in terms of effective making the life conditions of people suffering from atrial fibrillation better, while also bringing concrete, positive effects to the whole national Health System.
As we all know, atrial fibrillation is a particularly widespread problem. Recent researches showed that 1 out of 50 Italians suffers from this disease. Moreover, AF-related strokes are among the most severe ones, since the disability percentage linked to these tragic events reaches 60%, with the mortality percentage at 20% of the cases.
New oral anticoagulants are by far ahead in terms of effectively contrasting stroke: they're more effective on a therapeutical level, have less side effects and they're way easier to use. These new drugs are supposed to significantly improve the patients' life, and that by saving them from having blood coagulation level controlled in a specialized centre every single day.
And the physicians' work will be made easier, too: a simpler patients' management will undoubtedly ensure great clinical advantages to subjects suffering from AF, while also guaranteeing important savings in terms of national public expenditure.
Last but definitely not least, associations will play a key role in spreading the knowledge of these drugs, too: it's up to them to guide patients towards a correct use of new generation-oral anticoagulants, and that mostly by promoting awareness campaigns.
In short, available tools to fight atrial fibrillation are constantly increasing in terms of effectiveness: now the real focus should be on how to communicate them for the best.
Anthony Farina scores a goal against atrial fibrillation
He's a football player, and he's only 27 years old. And he's scored this career's most important goal: that against atrial fibrillation, which he managed to defeat thanks to the electric cardioversion.
Anthony Farina (born in Pavia, in 1985) joined the Olginatese footbal team last summer. But his League D season seemed to vanish soon after the first training sessions - namely as soon as he was diagnosed with atrial fibrillation, and forced to stop.
After a long center-forward career all over Italy, which started in Milan's junior team and continued in the Italian C and D Leagues - namely in teams such as Legnano, Sassari, Borgomanero, Caratese, Renate, Voghera and Marsala, as well as in the French Ligue 2, in Gueugnon - Farina was afraid of having to give up playing.
But he didn't lose his heart and consulted some specialists, who eventually reassured him about his condition. At the beginning of October, in Pavia, Anthony underwent electric cardioversion - a treatment that promptly restores normal heart rhythm.
All's well that ends well: now Anthony has come back to train with his team, and is currently waiting for the ultimate control and permission to take the field and play his first game of the season.
Good luck Anthony!
Drugs: a key risk factor of stroke in younger people
The recently celebrated World Stroke Day, on October, 29, 2012 has provided the ideal occasion to raise the alarm on a constantly increasing phenomenon - that of stroke in younger people. According to a research published in Neurology, the percentage of subjects between 20 and 54 years of age suffering from this disease has been increasing from 13% to 19% in the last 20 years.
Moreover, a dangerous, new risk factor has recently being added to traditional ones - such as hypertension, smoking and high cholesterol level: drugs - from amphetamine to cocaine - whose use has had a tenfold growth between 1994 and 2005.
That is one of the most striking issues coming from the eighth World Stroke Day, promoted by the World Stroke Organization - and one to be afraid of, since stroke is responsible for a 10-12% percentage of the overall deceases on a yearly basis in the Western World, while also being the first cause of disability and the second one of dementia.
Nevertheless, stroke awareness and information still seem to be particularly limited in Italy: according to a recent survey by A.L.I.Ce. Italia Onlus, in collaboration with Censis and the University of Florence, only 8 out of 100 Italians know that some cardiac abnormalities, like atrial fibrillation, are actually triggering factors for stroke.
Besides that, even if 77% of them think they know what stroke is about, less than 57% are able to to identify it as a brain disease, while almost 14% think it's a sort of heart attack, and 11% believe it is a blood disease.
Therefore, it's very important to develop and foster communication and information initiatives about stroke - and, more particularly, on atrial fibrillation. Atrial fibrillation-related ischaemic strokes, in fact, cause aworst disability than the others, but the great part of them may be avoided thanks to early diagnosis and access to proper treatments.
AF: Women Have A Higher Risk Of Stroke Than Men
When compared to elderly men suffering from AF, elderly women with AF have a significantly elevated risk for stroke: this is the result of a study published in the Journal of the American Medical Association..
Dr. Meytal Avgil Tsadok and colleagues of the McGill University Health Center, Montreal, reviewed data from Quebec, Canada on more than 80,000 AF patients at least 65 years of age. The risk for stroke among women remained elevated, regardless of their risk factors and warfarin treatment.
The authors wrote that “women older than 75 years represent the most important target population for stroke prevention in patients with AF, and the effectiveness of novel anticoagulants in this population in real-world practice needs to be closely monitored.”
As many know, gender-based differences related to AF have been identified, the most concerning being that women with AF have an increased risk for cardiovascular events, including stroke; it has also been suggested that underutilization of oral anticoagulation treatment among women has been a contributing factor to this increased risk.
Dr. Tsadok's staff's study included patients admitted to the hospital with recently diagnosed AF in the province of Quebec, Canada, from 1998-2007, using administrative data with linkage between hospital discharge, physicians, and prescription drug databases.
The study comprised 39,398 men (47.2 percent) and 44,115 women (52.8 percent). Generally, women were older (74.2 percent of women were older than 75 years, compared with 61.4 percent of men) and had higher risk factors than men. In general, adherence to anticoagulation therapy was relatively high and similar in both sexes.
However, the researchers found that stroke rates were significantly higher in women compared with men (5.8 percent vs. 4.3 percent), and that the difference between sexes was essentially driven by the rates in the older (75 years and older) patients.
According to the authors, "Older women had significantly higher rates of stroke than older men, regardless of warfarin use, and women had higher rates of stroke compared with men, regardless of adherence level”.
That said, the authors note that it is not yet known why women with AF are more susceptible to stroke. “The increased risk may be attributable to physiology (such as uncontrolled hypertension), vascular biology, genetic factors, hormonal or thromboembolic factors, or psychosocial factors that differ between men and women". Tellingly enough, these factors were unidentifiable in the staff's database.
October 29, 2012: World Stroke Day. "Because I care..."
On October, 29, 2012, the World Stroke Day will be officially celebrated all around the world: a great chance to try and provide the general community with proper information about stroke, by contrasting common misconceptions - "stroke only happens in late age", for example - and to help and support all those families, friends and caregivers who live at close contact with people suffering from stroke - day by day.
Launched by the World Stroke Organization in 2010, the World Stroke Day is a yearly not-to-be-missed appointment for everyone involved in stroke prevention. An ideal prosecution of the recent World Stroke Congress held in Brasilia a couple of weeks ago, this year's message will be focused both on numbers - with an impressive "1 in 6" appearing on all the campaign's communication tools, and representing the percentage of people who will be suffering from stroke once in their life - and on an effective headline: “Because I care… “.
The campaign also asks people to commit to six key challenges to prevent and avoid this disease:
- A better awareness of one's own risk factors: high blood pressure, diabetes, and high blood cholesterol
- Practising physical activities and exercises on a daily basis
- Maintaining a fruit- and vegetables-based diet, low in salt, in order to keep blood pressure low
- Limiting alcohol consumption
- Avoiding smoking
- Learning to recognize stroke's warning signs - and taking action against them
Dr. Raviele to attend "Advances in Cardiac Arrhythmias and Great Innovations in Cardiology" in Turin
ALFA President, Dr. Antonio Raviele, will take part in the forthcoming edition of the "Giornate Cardiologiche Piemontesi" (Piedmontese Cardiological Days), Advances in Cardiac Arrhythmias and Great Innovations in Cardiology, to be held in Turin, October 25-27, 2012, at the local Industrial Union Congress Center; Dr. Raviele will be involved in this international workshop both as a Member of the Faculty and as Chairman (together with Dr. R. Riccardi) of one of the most awaited session, scheduled for October 25, at 11.00 - Agnelli Hall: "Atrial fibrillation: new pathophysiological concepts
and novel pharmacological approaches".
Diabetes and obesity responsible for stroke risk increases in younger people
Unfortunately, stroke risk is increasing in younger people: 1 out of 5 among those who suffer a stroke is under 55 years of age. That's the most important result of a research published in the American Academy of Neurology Journal: the study included 1,3 million people, and comparison with reports dating back to 1993 (when under 55-years old patients suffering from stroke were 13%) are nothing but impressive, since the overall percentage has come to reach 19%. A worrying increase, that's for sure: the American Stroke Association has recently linked this dangerous trend with a constant increase of risk factors such as diabetes, obesity and high cholesterol level.
Moreover, the average age of elderly people suffering from stroke has significantly decreased from 71 (in 1993) to 69 years in 2005. "It is a widespread phenomenon" says Dr. Paola Santalucia, President of Women Stroke Association and Medical Director at Policlinico di Milano. "Stroke risk increases with age, but stroke cases in younger people are constantly growing: this is also due to a deeper study and analysis of the general population, particularly in terms of genetic and cardiovascular risks". However "Risk factors such as obesity and metabolic syndrome, which aren't necessarily linked with age, have a strong impact nowadays" concludes Dr. Santalucia, "but it must also be noticed that the real difference is that now we can detect more strokes in younger people - and that doesn't really mean their number is continuously growing".
Tomatoes are good… in stroke prevention!
Tomatoes, the key protagonists of the Mediterranean diet, obviously taste good… and they're also highly recommended in stroke prevention! According to a recent research by the Finnish Institute of Health and Nutrition these vegetables concur in decreasing the risk of stroke of an astonishing 50% - and if we think that - in Italy alone - stroke is the second cause of death and the first one of disability… Plus, a mere 50 grams seems to be enough to grant a protection of sorts.
The Finnish study started back at the beginning of the Nineties, involving a thousand men in
the small town of Kuopio, ranging from 46 to 65 years at the time. After 12 years, 67 among them had suffered a stroke, but no one among those who had a particularly high value of lycopene in their blood - and tomatoes are rich in lycopene…
"Yes, 67 cases are quite a few to come to exact conclusions" says Francesco Sofi, a researcher in Clinical Nutrition at the University of Florence, Italy, "but a close relationship between the consumption of vegetables and fruit and a lesser risk of stroke has been proved valid by various studies".
However, let us just say that lycopene is good for our health - and especially for those who have a higher risk of stroke, depending - for instance - from hypertension, excess weight or family history.
Best practices in AF video communication: Heart and Stroke Foundation of Canada
As we all know, AF is the most common heart rhythm condition, and it’s also the most common heart-related reason for hospital admission: it follows that communicating this arrhythmia's risks in the most effective way can be highly important in terms of awareness and prevention.
Canada's Heart and Stroke Foundation has recently offered two great examples with the following videos - the first one features Jeremy Taggart, a real-life rock drummer (with Toronto's Our Lady Peace), and is clearly focused on… well, rhythm, what else?
The second one - a spot for the Make Death Wait campaign - is perhaps a more touching, but nevertheless a highly compelling experience, too...
Moderate Drinking May Increase Risk of AF in People With Heart Disease
On October 1, 2012, both "ScienceDaily" and womenshealth.gov have reported a McMaster University's study - published by the Canadian Medical Association Journal (CMAJ) - on the effect of moderate alcohol consumption in increasing the risk of atrial fibrillation, particularly in older people with heart disease or diabetes.
"Moderate alcohol intake is strictly related with an increase in the incidence of AF in the elderly, and particularly in those patients with high cardiovascular disease or diabetes risk - and that apart from any occasional binge drinking episode," claims Dr. Koon Teo, among the authors of the study and Professor of Medicine at the Michael G. DeGroote School of Medicine at McMaster University in Hamilton, Canada, "Moreover, it must be noticed that among moderate drinkers with high AF risk, episodic binge drinking may cause an effect similar to that of habitual heavy drinking".
The study involved over 30,000 people (55-years or older) from 40 countries, suffering from cardiovascular diseases or advanced diabetes - the relevant trials followed the participants for four and half years.
Officially, moderate alcohol consumption's range goes from 1 to 14 drinks a week for women and from 1 to 21 a week for men, while binge drinking implies more than five drinks a day.
Reportedly, AF's incidence's rate rose to 6.3% in the low intake group, 7.8% in the moderate and 8.3% in the high intake groups; moreover, general increase of AF cases deriving from high alcohol consumption was found in each age group.
As many know, moderate drinkers represent about a third of the overall population: it follows that an increased alcohol consumption can have serious implications on the risk of atrial fibrillation for a large amount of patients suffering with pre-existing cardiovascular disease.
More of the same for healthy people indulging in binge drinking: the research proves that it may increase the risk of AF - luckily enough, moderate drinking in healthy individuals seems not to be connected to any increased risk.
US FDA: New Goal Date For Eliquis (apixaban)
The US Food and Drug Administration has recently postponed the decision date for Eliquis (Apixaban) to March 17, 2013. The new Prescription Drug User Fee Act (PDUFA) date was announced by the drug’s producers, namely Pfizer and Bristol-Myers Squibb.
As many know, the new drug application for stroke prevention in atrial fibrillation has been delayed twice. Yes, the ARISTOTLE trial was highly praised at its time of publication, but the FDA first extended its review by three months, only to issue a complete response letter on June 22, asking for “additional information on data management and verification from the ARISTOTLE trial.” Now, both Pfizer and Bristol-Myers Squibb have claimed that the FDA has accepted for evaluation their response to the above mentioned letter.
Tellingly enough, last week the European Committee for Medicinal Products for Human Use (CHMP) strongly recommended approval for apixaban for the same indication.
Eliquis is the approved trade name for apixaban in Europe, and it has also been proposed in the United States; at the moment, Eliquis is not approved for stroke or systemic embolism prevention in patients suffering from AF in any country.
It must be noticed that in May 2011, Bristol-Myers Squibb and Pfizer announced the first regulatory approval for Eliquis in the 27 countries of the European Union - plus Iceland and Norway - for the prevention of venous thromboembolic events in adult patients who have undergone elective hip or knee replacement surgery.
Asian populations with atrial fibrillation: different results from different therapeutical options
According to a report presented at the 2nd Asia Pacific Stroke Conference in Tokyo, Japan, Asian patients suffering from atrial fibrillation seem to have considerable benefits with a dabigatran etexilate-based treatment than with a warfarin-based one; significantly enough, patients treated with dabigatran seem to present risk reductions in the rate of haemorragic stroke and systemic embolism prevention.
As many know, atrial fibrillation has become a major issue in the Asian area: reportedly, there are currently over 8 million people being treated for this condition in China alone, while it seems that more than 5 million people suffer a first-ever AF-related stroke each year in the Asia-Pacific region - and it follows that numbers are expected to rise with the progressive aging of the population.
According to G. Lip, Professor of cardiovascular medicine at University of Birmingham Centre for Cardiovascular Sciences (UK), "The findings of this study reaffirm the efficacy and safety of dabigatran etexilate for the treatment of people living with atrial fibrillation around the world, and represent a further guidance and support for the use of oral anticoagulants in the treatment of atrial fibrillation for all the physicians and healthcare professionals operating in this region". It must also noticed that Asian patients spend less time within the therapeutic range than non-Asian ones (55% vs. 66%): a fact that puts these patients at increased risk of stroke and systemic embolism, and that it undoubtedly important for all those countries with high Asian sub-population, like the USA and the United Kingdom.
ALFA Presidents to take part to APHRS 2012 - Taipei, Taiwan
Dr. Raviele and Dr. Natale have been invited to take part in the forthcoming APHRS 2012 Sessions, to be held at the Taipei International Congress Centre - Taipei, Taiwan, October 3-6, 2012.
Besides being part of the Europe and USA Faculties respectively, both the ALFA Presidents will take part in some among the most relevant sessions of the APHRS Congress: on Thursday, October 4, Dr. Natale will speak about "Catheter Ablation of AF in Patients with Hypertrophic Cardiomyopathy", during the "Catheter Ablation of AF in Special Populations: Part I - How to Deal with AF Patients with Structural Heart Disease?" session, scheduled from 8.30 to 10.20, while Dr. Raviele will be among the moderators - together with Drs. Epstein (USA) and Namboodiri (India) - of the "Diagnostic Issue of Syncope" session, from 10.30 to 12.20.
On Friday, October 5, Dr. Natale will hold a speech on "Ablation Outcome and Complications in Elder Patients Receiving Catheter Ablation" at the "Meet the Expert III: How to do AF Catheter Ablation in Elder Patients?" session, scheduled from 16.00 to 17.30, while at the same time Dr. Raviele will take part in the "Revisit the Consensus Document on AF Ablation: European, North American and Asian-Pacific Guideline" session, with a speech titled "Update of Venice Chart International Consensus Document on AF Ablation 2011: What has Changed?"
On the last day of the Congress, Saturday, October 6, from 16.00 to 17.55, Dr Raviele will moderate the "Long Term Outcome Following AF Ablation: Can We Stop AF Progression?", together with Drs. Yao (China) and Takahashi (Japan). The same session will also host a Panel Discussion by Dr. Natale on "Long-Term Outcome of Catheter Ablation in Non-Paroxysmal AF", and one by Dr. Raviele, too, titled "Efficacy of Catheter Ablation of AF: Have the Result Fulfilled the Promise?".
Support To Global AF Patient Charter Tops 50,000 Signatures
The recently presented Global Atrial Fibrillation Patient Charter has lately achieved an outstanding result: that of topping 50,000 supporting signatures by patients, healthcare professionals, policy makers and the general public from 150 countries, in order to try and call for government attention and action on such an important topics as Atrial Fibrillation.
With tens of millions of people suffering from AF worldwide, evidence of a general under-diagnosis and under-treatment of this arrhythmia seems more than obvious today.
In order to try and fight the course of things the Global AF Patient Charter aims at defining solutions to combat the most threatening among AF's consequences: stroke. That's the reason why, following the Sign Against Stroke in Atrial Fibrillation campaign's launch, earlier this year, at the World Heart Federation’s World Congress of Cardiology in Dubai, several medical and patient organisations from all over the world have decided to endorse the Charter, in the attempt of demonstrating that an earlier detection of this disease may be the key to try and give people the best possible care and treatment options.
The Charter is currently available in 22 languages on the campaign website: www.signagainststroke.com
Heart Rhythm Society: September, The Atrial Fibrillation Awareness Month
More public education, knowledge and awareness - on an issue as serious as Atrial Fibrillation, but also on its symptoms and available treatments, too: that's the aim of the Heart Rhythm Society in designating September as the AF Awareness Month.
Once again, numbers say it all: AF is largely the most common arrhythmia, affecting over 2.5 million American and 4.5 million EU citizens, while also being responsible for one-third of hospitalizations as consequences of cardiac rhythm disturbances. But that's not all: this condition has a very severe impact on patients' life, and also increases the risk of stroke in quite an impressive percentage: +500%.
Do you need more numbers? 88,000 AF-related deaths and $16 billion in additional costs to the U.S. healthcare system alone - and if it still isn't enough, with an increasingly aging population, these numbers are expected to double within the next 30 years…
Firstly approved by the U.S. Senate back in 2009, the HRS-endorsed AF Awareness Month project has been gaining visibility throughout the years: many of us remember the "A-Fib Feels Like" national broadcast public announcement campaign - but awareness ads displayed in a worldwide-famous location such as new York's Times Square are even more effective.
The ten commandments to prevent cardiovascular diseases through sport
1. Practise moderately-intense at least 30 minutes a day, 5-7 times a week, and highly-intense endurance physical activities at least 20 minutes a day, 2-3 times a week.
2. You may reach 30 minutes of daily activity by adding shorter periods of at least 10 minutes each.
3. If you're obese or overweight, extend the moderately intense activity up to 60 minutes a day, 5-7 times a week.
4. Practise moderately intense activities in order to maintain your muscle strength and resistance at least 2-3 times a week.
5. Practise stretching exercises at least 10 minutes a day, 2-3 times a week.
6. If you wish to improve your physical condition even further, you may exceed the above-mentioned minimum quantity of recommended activity.
7. In case you sense the so-called "alarm symptoms", promptly stop your physical activity and ask your doctor for medical advice.
8. First of all, ask your doctor for medical advice if you suffer from heart diseases or have cardiovascular risk factors
9. Do not practise any physical activity in case of adverse environmental conditions and if you're not feeling well.
10. Reduce the risk of accidents and that of giving up practising sport by choosing a highly-enjoyable, diverse kind of physical activity, to be practised along with the others.
Female obesity triples the risk of atrial fibrillation
We all know that excess weight are a heavy burden for our heart to carry, too - particularly for women. In fact, female obesity increases the risk of atrial fibrillation - the most widespread cardiac arrhythmia, whose effects can be severe.
A recent research, presented during the ESC 2012 Congress in Munich, showed how, for an obese woman of fertile age, probabilities to be affected by atrial fibrillation nearly double - and even triple, in cases of great obesity. The study, chaired by Prof. Deniz Karasov, from the Copenhagen University Hospital in Gentofte (Denmark), has quickly gained massive attention on the net, and has been variously reprised and commented on many websites and blogs: however, it must be noticed that many other risk factors may have a primary importance in causing atrial fibrillation - genetic predisposition, inflammation, obstructive apneas while sleeping, alcoholic abuse and too much physical activity, to name but a few.
Besides that, reported data on cardiovascular diseases-related deaths all over Europe are highly impressive, too: 4,3 million people per year, with a female percentage which largely overcomes the male one. Moreover, the study also highlighted the deplorable trend of underdiagnosis of female cardiopathies, which are often worse cured than male ones.
Atrial fibrillation and left ventricular hypertrophy
The recent ESC 2012 Congress also hosted the presentation of the “Prognostic Value of Left Ventricular Hypertrophy by Electrocardiography in Patients with Atrial Fibrillation” study.
For the first time ever, the study showed evidence of left ventricular hypertrophy - diagnosed through electrocardiography - in being highly-predictive of total and cardiovascular mortality, myocardial infarction and cerebral stroke in patients with atrial fibrillation.
The “Prognostic Value of Left Ventricular Hypertrophy by Electrocardiography in Patients with Atrial Fibrillation” study derives from the RE-LY one, and has been carried out by an international task force, which examined about 18.000 patients who were previously included in the RE-LY research, in over 900 centers in 44 countries. The project study has been chaired by Dr. Paolo Verdecchia, Director of the Operational Unit of Medicine at the Assisi Hospital, and by Dr. Giuseppe Di Pasquale, Director of the Operational Unit of Cardiology at the Maggiore Hospital in Bologna.
1 out of 50 Italians suffer from atrial fibrillation
Atrial fibrillation is a national health emergency. According to a recent study, this pathology affects 1 out of 50 Italians, thus confirming a fast-growing incidence trend.
These are the conclusions coming from an Italian study which has been recently presented at the ESC 2012 Congress: the research - called ISAF, "Italian Survey on Atrial Fibrillation management" - has been targeted on general practitioners, and has clearly proved atrial fibrillation to be a highly widespread condition.
The ISAF study involved 296.000 Italian patients and 230 general practitioners. The most striking result is that coming from the diffusion of the pathology: reportedly, 2,04% of the national population suffer from atrial fibrillation - that means no less than 1 out of 50 Italians - and it must be noticed that previous researches showed a percentage of 1 out of 100.
“A key point in our analysis," claimed Dr. Massimo Zoni-Berisso, from the ASL 3 "Genovese" Cardiology Department in Genoa, Chairman of the ISAF study, "is that of the highly insufficient use of the anticoagulant therapy in some sub-groups of patients: also, it must be noticed that the research has highlighted a positive trend of sorts in the course of years, with a general improvement in the use of this kind of therapy by general practitioners”.
40.000 stroke-related deaths can be avoided thanks to anticoagulants that are still unauthorized in Italy
Dabigatran, rivaroxaban - and apixaban to follow soon. Europe moves towards the future, while Italy stands still. These are some of the topics that were recently discussed at the ESC Congress, which took place in Munich.
The new oral anticoagulants, dabigatran and rivaroxaban, are already available in 4 out of 5 major European countries - except in Italy. Moreover, results about the use of dabigatran in the treatments of 1 million patients during the last year are highly encouraging: 40.000 stroke-related deaths have been avoided.
As we all know, atrial fibrillation is a key factor in increasing the risk of stroke - at least 5 times more. Patients suffering from this kind of arrhythmia should be treated with an antithrombotic therapy.
In Italy, VAKs (Vitamin K Antagonists) are the only currently available anticoagulants: that means serious issues with administration, costs, need for periodical analyses and various risks of interaction with other drugs - and even with some kinds of food. The novel OACs (Oral AntiCoagulants), on the other hand, offer great improvements: dabigatran and rivaroxaban have already been approved by the USA and UE drug agencies, while apixaban has recently successfully passed AF-related experimentation, and is currently waiting for final authorization.
The new OACs have higher costs, but it must be noticed that the initial expense will be completely absorbed by a higher therapeutical efficacy, as well as by a stricter adherence to therapy by most of the patients, since their use is far easier than that of VAKs.
Warfarin, dabigatran, apixaban and rivaroxaban: highlights from the AHA/ASA guidelines
Warfarin, dabigatran, apixaban and rivaroxaban are all recommended in the prevention of stroke in patients with non-valvular atrial fibrillation, according to the new guidelines on stroke prevention in patients suffering from atrial fibrillation coming from the American Heart Association and the American Stroke Association.
According to the document, "choosing an anticoagulant should imply attention to risk factors, costs, tolerability, the patient's preference, drugs' interactions and other clinical characteristics, including the period within the INR therapeutical range if the patient is taking warfarin”.
Experts consider new agents such as apixaban and rivaroxaban easy to use: they have few drug interactions and don't need any monitoring activity. But kidney functionality must be controlled: it may be necessary to adjust the dosage or contraindications to the administration of new anticoagulants may occur, depending on the clearance value of creatinine.
These alternatives to warfarin, thanks to a less complex management of the therapy, may allow the treatment of a higher number of patients - even if these new drugs may imply a higher bleeding risk. However, a recent report by EMA has showed a lower occurrence of fatal bleeding cases associated with the administration of dabigatran during post-marketing monitoring compared to that registered during the clinical studies.
Update on Atrial Fibrillation: novel oral anticoagulants included
ESC - European Society of Cardiology - has recently issued AFib - Guidelines for the Management of Atrial Fibrillation (including the Focused Update 2012).
While presenting the updated guidelines, the current ESC President, Prof. P.E. Vardas, pointed out the main distinctions between the 2012 update and its predecessor. "First of all, talking about stroke prevention, additional evidence has strengthened the use of CHA"DS"-VASc score to identificate "truly low-risk" patients, with no need for any kind of antithrombotic therapy - and also of novel oral anticoagulants as an alternative to dose-adjusted vitamin K antagonists".
The update clearly demonstrates that the aspirin serves poorly in stroke prevention: indeed, it may cause a potential harm, since its risk of major bleeding doesn't significantly differ from that of oral anticoagulants - especially in elderly people.
"The novel OACs offer efficacy, safety and convenience, too, particularly when compared with oral anticoagulation with VKAs. It means that novel OACs are often preferable to adjusted-dose VKA for most patients with non valvular AF - moreover, at the moment there is insufficient evidence in recommending one novel OAC over another".
Speaking about the key additions on the pharmacological cardioversion of AF, Prof. Vardas claimed that "The most important one is the introduction of vernakalant, a new intravenous antiarrhythmic agent approved for cardioversion of AF of < 7 days or > 3 days after cardiac surgery. This agent is contraindicated in hypotension < 100 mm Hg, recent acute coronary syndrome, NYHA class III and IV heart failure, severe aortic stenosis and QT interval prolongation".
The guidelines also confirm the revised use of dronedarone as appropriate in maintaining sinus rhythm and reducing the need for cardiovascular hospitalization in patients with paroxysmal or persistent AF - it shouldn't be used in permanent AF and heart failure patients.
Last but not least, the update highlights the importance of catheter ablation for symptomatic paroxysmal AF in patients who have previously failed a trial of antiarrhythmic medication, to class IA.
"The 2012 focused update on AF has undoubtedly set new standards of clinical excellence, whose implementation will surely have a great impact on reducing the complications of this arrhythmia", concluded Prof. Vardas.
Best practices in campaigns against Atrial Fibrillation
World Heart Federation launches Global AF Action
As we all know, Atrial Fibrillation is a growing and urgent public health concern: it is the most common arrhythmia worldwide, and last reports talk of an estimated nine million people currently affected in Europe and the US - and numbers are certainly bound to increase.
Atrial Fibrillation worsens the patients' general life conditions, while also carrying AF a 4- to 5-fold increased risk of stroke, and is also strictly associated with a particularly high risk of cardiovascular events and hospitalization. But the most important thing, as we said before, is that people suffering from this arrhythmia often have to face a considerably impaired quality of life.
in order to try and contrast these and other AF-related issues, World Heart Federation has created a Global AF Action (GAFA) campaign, set to encourage its members - as well as individuals - to take action and fight against AF and AF-related stroke. GAFA is an international awareness and action campaign which aims at reducing premature cardiovascular disease mortality by 25% by 2025, in coherence with the WHO Target.
The campaign's goal is that of gaining greater recognition for this arrhythmia, by making it a major international public health concern - apart from AF-related costs and their burden on worldwide healthcare systems, the disease has also further indirect costs due to rehabilitation and lost work, both in terms of sickness absence and early retirement.
American Journal of Cardiology: hospitalized AF patients suffer from the "weekend effect".
A nationwide study published by The American Journal of Cardiology, based on a nearly 90,000 U.S. hospitalizations for atrial fibrillation, has recently brought to attention a key gap in weekend care. According to the study, about 20% of the irregular heart-rhythm patients studied were hospitalized over the weekend, and 1.1% of these patients died (against 0.9% of the patients admitted during the week). After adjusting for hospital and patient characteristics and patient co-morbidities, the weekend patients had a 24% higher chance of dying compared with weekday patients.
Moreover, weekend patients were half as likely to receive electrical cardioversion: and when they did, they had to wait longer for the treatment.
“I see many patients admitted for atrial fibrillation on the weekends,” claimed the study’s lead author, Abhishek Deshmukh, MD, a cardiology fellow at the University of Arkansas for Medical Sciences in Little Rock. “I personally thought that we are probably missing cardioversion in some of these patients, maybe because it requires a lot of manpower to be performed, and it would be difficult to organize this over the weekend. As for my personal experience, we're probably not cardioverting much on the weekends unless the patient is extremely sick.”
Many cardiologists interviewed for this article said more research needs to be done to verify that the so-called "weekend effect" in AF treatment.
"The electrical cardioversion's rate is unlikely to explain the higher weekend death rate, since this kind procedure has not been shown to be superior to treating atrial fibrillation with heart-rate controlling medications alone", said Stuart Winston, DO, a cardiac electrophysiologist at the Michigan Heart & Vascular Institute of St. Joseph Mercy Health System in Ann Arbor, and a member of the American College of Cardiology’s board of trustees, "moreover, weekend admits are almost always going to be a sicker group and usually come through the emergency department".
“I won't call it a "weekend effect", said Dr. Harlan Krumholz, MD, a cardiologist and director of the Yale-New Haven Hospital Center for Outcomes Research and Evaluation in Connecticut, "weekend systems tend to differ from the workweek ones, and hospitals should search for vulnerabilities in our systems that can cause errors and oversights that could put patients at greater risk”.
Improvements are possible, and disparities must be eliminated. In 2000, weekend heart-attack patients had a 10% higher death rate than those treated during the workweek, according to an analysis of nationwide data that Dr. Deshmukh presented last year at the Transcatheter Cardiovascular Therapeutics meeting in San Francisco - tellingly enough, he reported, by2008 the gap had disappeared.
"The key message coming from this kind of research is that physicians and hospitals should improve care regardless of when patients are admitted", said Christopher Granger, MD, a spokesman for the American Heart Association and director of the cardiac care unit at the Duke Clinical Research Institute in Durham, N.C., "as health care providers, we have to review our standardized protocols for how we treat patients, to assure that no matter when they present that they’re getting evidence-based, guideline-based care.”
Best practices in campaigns against Atrial Fibrillation
Good Results for HRS Boston Citywide Awareness Campaign on AF and SCA
As many know, in order to raise awareness and support consumer education about heart rhythm disorders - with particular attention to Atrial Fibrillation (AF) and Sudden Cardiac Arrest (SCA) - the Heart Rhythm Society (HRS) launched a Boston Citywide Awareness Campaign, whose start coincided with Heart Rhythm 2012. The campaign aimed at increasing the citizens' knowledge of symptoms and available treatment options for these diseases - namely the most common among arrhythmia disorders, affecting millions of people all over the world.
Last May was proclaimed Cardiac Arrhythmia Awareness Month in Massachussets by Governor D. Patrick, while Mayor T. Menino declared May, 9 as Cardiac Arrhythmia Awareness Day in Boston.
Media were obviously involved: local television stations hosted 10- and 30- seconds AF public service announcements, while 25 articles on AF were written in local Boston print - furthermore, press releases were distributed and picked up by more than 300 outlets across the US. Radio did its part, too: spots received 140 + airings, inviting listeners to attend the "Know your Rhythm; Save Your Life" event at City Hall Plaza.
There were over 219,000 social media interactions, including tweets and Facebook posts, directly related to the campaign and to the above mentioned event at City Hall Plaza, which was staffed by health care professionals from Massachusetts General Hospital, Brigham & Women’s Hospital, North Shore Medical Center, PrepMD, Stereotaxis, HRS and Schwartz MSL. Besides that, resource kits were distributed to foster discussions between patients and caregivers about the most important health disorders.
Although the Boston Citywide Awareness Campaign was a success, HRS admits that there is much more work to be done: the Society will continue to build awareness of heart rhythm disorders throughout the year, particularly during September (which has been proclaimed National Atrial Fibrillation Awareness Month) and October (National Sudden Cardiac Arrest Awareness Month).
Poor Medication Adherence: Collaborative Efforts to Contrast It
Medication non-adherence is a growing public health concern.
The problem is especially critical in the U.S., as the number of Americans affected by a chronic condition requiring medication therapy is expected to grow from 133 to 157 million by 2020. Nearly 3 out of 4 Americans admit that they do not always take their medication as directed: this causes more than one-third of medicine-related hospitalizations, nearly 125,000 deaths in the U.S. and $290 billion in avoidable costs to the health care system each year.
These are some key reasons behind the ACC-endorsed, "Script Your Future" campaign, led by the National Consumers League (NCL), addressing the need for tools and resources to support medication adherence across the country, while contemporaneously opening dialogue between health care professionals and patients about the health consequences of non-adherence. The three-year campaign essentially targets those who suffer from three chronic conditions: cardiovascular, diabetes and respiratory; it is partnered by diverse groups, and aims at reaching patients via a variety of relationships – through open dialogue with doctors, pharmacists, nurses, caregivers, and other health care professionals.
Script Your Future also affords opportunities to promote CardioSmart tools, such as the new CardioSmart Med Reminder app. This app is free to iPhone and iPad users, and is intended to serve as a medication and prescription refill reminder, as well as a personal medication record, to help patients communicate with health care providers about the medications they are taking.
This summer, the ACC and CardioSmart are promoting a “Don’t Take a Vacation from Your Medication” campaign on social media channels, to encourage patients to not forget about taking their medication.
Shift Work Linked To Higher Risk Of Heart Attack and Stroke
An analysis that reviews studies covering over two million people finds shift work is associated with a higher risk for vascular events, such as heart attack and ischemic stroke.
The researchers, from Canada and Norway, write about their findings in a paper published online in the BMJ on Thursday.
They report that compared to regular daytime workers, shift workers had a 24% higher risk for coronary events, a 23% higher risk for heart attack, and a 5% higher risk for stroke, while night shift workers had the highest risk for coronary events (41%).
Bu why study Shift Work? Scientists have known for a while that shift work upsets the body's natural body clock (the so-called circadian rhythm) and work-life balance, and a number of studies have linked it to health problems, such as increased risk of high blood pressure and high cholesterol; a link with diabetes is also well-established, too, while also the link with cancer has already made a mark in the politics of occupational health, since 38 Danish female night shift workers in 2008 were compensated after their breast cancer was officially recognized as an occupational illness.
However, the link between shift work and vascular disease is controversial. The authors propose one reason could be the varying methods, populations and definitions of shift work and coronary events that previous studies have used.
The international team - led by Daniel G Hackam, associate professor in the Department of Epidemiology and Biostatistics at Western University in Canada - analyzed the results of 34 studies covering 2,011,935 people, and compared shift workers to regular daytime workers or the general population. The researchers defined shift working as working patterns that differed from regular daytime working (9 am to 5 pm), including evening shifts, irregular or unspecified shifts, mixed schedules, night shifts and rotating shifts.
Of the more than 2 million participants, 17,357 experienced some kind of coronary event, 6,598 had heart attacks (myocardial infarction), and 1,854 had ischaemic strokes. An ischaemic stroke is caused by a lack of blood supply in the brain: the analysis showed all these vascular events were significantly more common among shift workers than other people.
The researchers say that although the relative risks they calculated are modest, because of the high frequency of shift work in the general population, the implications for public health are not insignificant - indeed, these findings should impact public policy and occupational medicine - for example, by educating shift workers to spot early signs of heart problems and to undergo screening programmes, in order to identify and treat risk factors like high blood pressure and cholesterol.
Atrial Fibrillation: New Technology Doubles Treatment Success Rate
A new type of technology that precisely targets the causes of irregular heart rhythms in patients with atrial fibrillation has the potential to nearly double the success rate of treating the condition, according to a landmark study published online in the Journal of the American College of Cardiology: it seems that the method achieved an 86% improvement on the current treatment.
Researchers from the University of California Los Angeles (UCLA) and Indiana Universit report having found that the irregular heart rhythms of atrial fibrillation are caused by small electrical localized sources or "hotspots" inside the heart called focal impulses or rotors: this should imply a "simpler" view on atrial fibrillation, rather than the conventional one, based on the assumption that the waves that cause the disturbance are chaotic and non-localized, thus requiring a lengthy procedure to eliminate.
Lead author Sanjiv Narayan, a professor of medicine at UC San Diego, visiting professor at the UCLA Cardiac Arrhythmia Center, and director of electrophysiology at the San Diego Veterans Affairs Medical Center, recently told the press that his group used a new type of physiological mapping called FIRM (Focal Impulse and Rotor Modulation), to locate the electrical hotspots and shut them down in a matter of a few minutes. this new targeting technology produces long-lasting results.
The study is part of a larger trial called CONFIRM, which stands for Conventional Ablation for Atrial Fibrillation With or Without Focal Impulse and Rotor Modulation: the trial examined 107 cases of patients referred for non-surgical catheter ablation to treat paroxysmal or persistent (72%) atrial fibrillation.
36 of the patients underwent conventional ablation where the hotspots were first located using the new technology ("FIRM-guided"), while the other 71 had conventional ablation alone.
The results show that in 86% of the FIRM-guided patients, the new procedure allowed the doctors to shut down or very significantly slow atrial fibrillation in an average of just 2.5 minutes.
The patients were followed for at least two years after their procedures: during that time they wore implanted ECG monitors that accurately tracked their heart rhythms over time.When they examined the ECG readings, the researchers found that the group that underwent FIRM-guided catheter ablation had 82.4% freedom from atrial fibrillation episodes compared with only 44.9% in the group that had only conventional catheter ablation.
Narayan and co-author Kalyanam Shivkumar, director of the UCLA Cardiac Arrhythmia Center and a professor of medicine and radiological sciences at UCLAsaid they were excited by the results that showed how "brief FIRM guided ablation can shut down the arrhythmia and bring the heart back to a normal rhythm after only minutes of ablation".
Correcting Rapid Heart Rhythms In Children Through the 'Heart Maps'
The first study of a procedure to make three-dimensional "maps" of electrical signals in children's hearts could help cardiologists correct rapid heart rhythms in young patients, according to new research presented at the American Heart Association's Basic Cardiovascular Sciences 2012 Scientific Sessions.
Children with the condition atrioventricular nodal reentrant tachycardia, suffer from disruptions in the heart's electrical system that cause sudden rapid heart rates. Patients have been successfully treated with cardiac ablation, in which the abnormal tissue that causes the condition is destroyed by freezing (the so-called cryoablation).
It can be a difficult procedure because every patient may have a different area of abnormal tissue causing the arrhythmia - plus, no research has been done on children until now.
"This is the first study to look at this technique from a pediatric perspective," said Lindsey Malloy, D.O., lead researcher and a cardiology fellow and researcher at University of Iowa Children's Hospital in Iowa City. "and we believe it has the potential to improve ablation success rates."
Malloy and her colleagues created three-dimensional voltage maps of the right atrium (the upper chamber of the heart), using electrical recordings from inside the heart. They also identified a bridge of low voltage signals surrounded by even lower voltage tissue, a sort of "saddle", where there was reduced electrical activity.
Twenty-nine patients between the ages of 7 and 20 were included in the study.
Physicians performed guided cryoablation of the abnormal electrical pathway using the bridge identified by voltage mapping. In 25 of 29 patients, there was an adequate voltage bridge to allow guided ablation, while the successful ablation site was within the first three lesions in 15 out of 25 patients.
"This use of voltage-guided mapping of this voltage bridge in AVNRT appears to be both safe and very effective in children while providing for more precise electrically guided ablation," Malloy said.
Could this artificial jellyfish be the first biological pacemaker?
The question is intriguing: could this artificially-created jellyfish be the first step towards changing pacemakers as we know them?
According to a report in the Daily Mail, the jellyfish - made from silicone and heart tissue from... rats - could be used to help create a new generation of ‘biological’ pacemakers which do not need electrical signals.
The medusoid has been created by researchers of the California Institute of Technology, after studying the fast muscle contractions which propel these animals through the water.
They put it in a tank of ocean-like salt water fitted with an electric current and managed to ‘shock’ it into synchronised movements like a real jellyfish: the scientists aim at making it pulsate by itself through, as human hearts do. The equipe's goal is that of using the jellyfish to create pacemakers that do not need electrical signals or even to engineer new organs after heart failure.
The researchers said this could be a ‘glimpse into the future of re-engineering whole organisms’ to advance medical technology: lead author Janna Nawroth, a biology PhD student at Caltech, said of the study – published in Nature Biotechnology: ‘A big goal of our study was to advance tissue engineering: our idea was that we would make jellyfish functions – swimming and creating feeding currents – as our target and then build a structure based on that information.’
London 2012 Olympics: British rower Tom James back in action after recurrence of AF-related problem.
Tom James, Britain’s coxless fours Olympic champion, has revealed that he missed training on Wednesday, July 25th, 2012 because of a recurrence of the heart condition he developed during the winter. The British champion decided to stop and have a day off, in order to try and get back in full form for the forthcoming challenges.
The British team didn't provide further information on James's cardiac problem - though news about his heart rate condition are absolutely optimistic.
James was temporarily replaced in the boat by reserve Cameron Nichol: the athlete's heart rate was particularly elevated after a hot and tiring training day on Tuesday, July 24th. As many know, James was diagnosed atrial fibrillation in January, and even if his problem is currently managed by medication, the rower obviously doesn't want to take any risk.
“I just had a bit of a raised heart rate in thet morning, so I just stayed in and let the others go for a row. The heart rate was back down a few hours later. I'm fine now, but sometimes you’ve got to take precautions – a day off is the best way to to ensure you recover properly. I’m now back on a ordinary full-day training.”
Here come the Olympic Games: but what about cardiac prevention in sports?
Dr. Sanjay Sharma, head of the cardiology team for the 2012 Olympics, will do everything possible - together with his team - to make sure a major cardiac event doesn't win the spotlight on sports' biggest international celebration. In recent months, some international athletes - like soccer star Fabrice Muamba - have been struck by sudden cardiac death. Muamba survived: and it was mainly his case who attracted media attention on the topic of prevention. But what about London 2012?
In a recent interview, Sharma told that he and his team have been screening around 1000 potential Olympians in the only UK-based sports cardiology clinic: two athletes have been told to suffer withWolff-Parkinson-White syndrome - as a consequence, they would have to have a catheter ablation in order to participate in the Olympic Games - as for now, Sharma himself doesn't know if they've made it to the final squad.
However, universal consensus on mandatory screening for athletes still seems quite far: yes, the International Olympic Committee has recommended - but not mandated - that all countries screen their athletes to minimize the risk of sudden death, and many screening programs also include an echocardiogram. But the American Heart Association (AHA) and the American College of Cardiology (ACC) don't recommend the use of ECGs for athletes - more of the same for the Canadian Heart and Stroke Foundation.
Tellingly, the Italian model seems to differ - and for the better: as many know, in Italy individuals aren't allowed to participate in sports unless they have had a family history taken, physical examination, and 12-lead ECG.
So what about the US? Once more, costs seem to be an issue - along with the risk of false positives that may cause some healthy kids to be forced to leave any activity. Obviously enough, the 12-lead ECG makes sense: it's the standard of care for professional athletes from the most important sport leagues both in Europe and North America - like NHL, NBA and MLB, among others.
It seems the Italian approach has failed to catch on in some countries because not all sporting authorities have accepted Italian estimates for sudden cardiac death—at approximately one in 50 000 athletes - but recent analyses, performed by the NCAA, confirm the Italian numbers.
It must be noticed that certain groups of athletes are undoubtedly at higher risk than others: and we're talking about basketball, soccer and football players, but also swimmers and cross-country skiers.
According to Sharma, prevention is the real deal: even minimal intervention in a 16-year-old with a serious cardiac condition gives back about five decades of life, compared with aggressive intervention in ischemic heart disease and left ventricular systolic dysfunction, which only gives back about five to 10 years. "We spend millions and millions on octogenarians to get back two or three years, and nothing on the youngsters to get back 70 years of life," said the English specialist.
Brand new FIGHT AF app or iPad - available now on App Store!
After the massive success of the 2011 edition, the STOP FA / FIGHT AF awareness campaign against Atrial Fibrillation is back again in 2012 - with new communication initiatives.
The first one is the brand new video "Atrial Fibrillation: Knowing It To Avoid Its Risks", whose iPad version is available now for free download on App Store - just search the Store for “Fight AF”.
Drs. Antonio Raviele and Andrea Natale, Presidents of ALFA – ALliance to Fight Atrial fibrillation - will introduce the app to the scientific community at Heart Rhythm 2012, to be held in Boston, May 9-12, 2012.
The 33rd edition of the event promoted by the Heart Rhythm Society, focused on sharing and discussing the latest innovations and researches in the cardiological field, will be the perfect context for presenting the new STOP FA / FIGHT AF communication tool, intended as an interesting follow-up of the education and awareness campaign launched in 2011.
The year of STOP FA: the campaign in figures
STOP FA, the Italian health education and awareness campaign promoted by ALFA, with the unconditioned support by Sanofi, hit the whole country, thanks to highly-effective communication and information tools and to the STOP FA DAY held on October 2, 2011. 2011.
Let's have a look at the campaign in figures:
Distribution of communication and information tools:
27.000 colour booklets (23.000 in Italian, 4.000 in English language)
7.000 DVDs of the educational 3D video (3.000 in Italian, 4.000 in English)
Addressees of the communication and information tools:
252 family physicians in the Venice province
158 state hospitals (86 in Northern Italy, 16 in Central Italy, 56 in Southern and Insular Italy)
170 cardiological centers (99 in Northern Italy, 24 in Central Italy, 47 in Southern and Insular Italy)
56 medical associations
51 patients' associations
38 foundations and private hospitals (27 in Northern Italy, 4 in Central Italy, 6 in Southern and Insular Italy, 1 in Switzerland)
30 institutional bodies - regional, provincial and city boards
1 international cardiological congress (Venice Arrhythmias 2011)
The STOP FA DAY in figures:
7: the number of cities involved (Bari, Bergamo, Catania, Florence, Naples, Rome and Venice-Mestre)
10.000: the number of people who visited the ALFA/STOP FA's gazebos
1.000: the number of performed controls (between ECGs at the gazebos and private visits)
Dr. Raviele and Dr. Natale to participate to AFA/Europe AF Patients Day in London
A key occasion of meetings and debates between worldwide-known specialists and patients suffering from Atrial Fibrillation: that's what AFA Patients Day is. The next edition will be held in London, on November 21, 2011, during the first day of the Europe AF congress, the international event attended by many among the most important experts in this increasingly widespread arrhythmia.
Dr. Antionio Raviele and Dr. Andrea Natale, VeniceArrhythmias' President and Co-President respectively (and holding the same offices at Stop FA's Scientific Committee and at ALFA's Promoting Committee), have been both invited to take part to the prestigious Faculty of the Europe AF congress, along with widely renowned colleagues.
The AFA Patients Days aim at favouring a close interaction between cardiologists, patients and medical professionals, in a process of mutual exchange of significant experiences. Furthermore, the contextualization of a Patients Day within the above mentioned event offers the opportunity to be informed about the latest scientific upgrades, technological innovations and treatment strategies to contrast and prevent Atrial Fibrillation.
Dr. Raviele will chair - along with Dr. Sam Levy - a highly-interesting session on Monday, November 21, at 10.20: USING DRUGS TO TREAT AF: HOW TO CHOOSE? - the session will host contributions by Dr. D. George Wyse, Prof. A. John Camm and Dr. Gregory Lip. On the same day, at 16.45, Dr. Natale will participate into an intriguing Pro / Con Debate, together with Dr. Albert J. Waldo: THIS HOUSE BELIEVES THAT ABLATION SHOULD NOT BE OFFERED TO PATIENTS WITH ASYMPTOMATIC AF.
Download the AFA/Europe AF Patients Day 2011 invitation / program
Further information about AFA Patients Days: www.atrialfibrillation.org.uk
Further information about Europe AF : www.europeaf.com
A STOP FA DAY for 10,000 people - a great success for ALFA!
Sunday, October 2, 2011: a date to rememeber for ALFA, since STOP FA DAY - the national Italian day to combat Atrial Fibrillation, part of the awareness campaign STOP FA - has been a massive success: the initiative - involving seven among the most important Italian cities and thousands of participants - has had an extensive media coverage.
10,000 people visited the STOP FA/ALFA info points set up in Bari, Bergamo, Catania, Naples, Florence, Rome and Venice-Mestre, in order to check their heart rate and - in case of anomalies - receive a free check-up.
The top Italian newspapers have granted great coverage to the event, giving useful information on the initiative and on Atrial Fibrillation, the widespread arrhythmia currently affecting 1 out of 100 Italians.
As we said before, STOP FA DAY has been a part of the national health awareness campaign STOP FA - promoted by ALFA - ALliance to Fight Atrial fibrillation, thanks to the unconditioned support from Sanofi.