A 21-Year-Old Man with Syncope and Palpitations: Case Presentation

MedScape
Mark P. Brady, PA-C Contributor Information
April 16, 2013

21yrold-medscape1

Image courtesy of the U.S. Navy.

 

 

 

 

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Can catheter ablation of AF ever be compatible with a less-is-more approach?

From Trials and Fibrillations with Dr John Mandrola
theheart.org
Mar 18, 2013 10:56 EDT

Here’s a challenge: Pick up a cardiology or electrophysiology journal and show me a negative piece about catheter ablation of atrial fibrillation. It’s true; our world is mostly free of doubters.

Then there is the real world, one populated with other medical specialties, and those daring enough to ask, “What, exactly, are you ablating?” As it turns out, not all doctors think so highly of the notion of ablating a disease that we do not fully understand.

Dr Rita Redberg, influential cardiologist and editor of the JAMA Internal Medicine “Less is More” series, said this about ablating AF:

“Because ablation has never been studied in a randomized blinded fashion, we cannot know whether patients experience fewer symptoms after ablation because subjective symptoms frequently decrease following a procedure or whether the ablation itself was beneficial.

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Freezing heart tissue halts atrial fibrillation better than drugs, study says

Los Angeles Times
March 16, 2010 |  4:28 pm

An experimental device that uses a catheter-based probe to freeze a tiny area of the heart that causes erratic electrical impulses is much better than drugs at curing atrial fibrillation, researchers reported Monday at the Atlanta meeting of the American College of Cardiology. The device is expected to provide an alternative to current non-invasive techniques that use radio frequency energy to burn away the tissue.

Atrial fibrillation, which affects an estimated 2.7 million Americans and as many as 10 million people worldwide, is the result of aberrant electrical signals that cause the heart to quiver rather than beat strongly. That allows blood to pool in the heart, where it can form clots that cause strokes and heart problems. Patients also suffer chronic fatigue, difficulty breathing and heart failure.

About half of all patients fail drug treatment and require more aggressive approaches. Surgeons used to perform open-chest surgery to access the heart and cauterize the electrically irritable tissue. About a year ago, the Food and Drug Administration approved the first catheter-based system to perform the procedure, Johnson & Johnson’s ThermoCool system, which burns away the undesirable tissue with radio frequency (Rf) energy. In this approach, a catheter is threaded through a blood vessel in the groin to the heart, where the tip is used to ablate the tissue. The new instrument, called the Arctic Front Cardiac CryoAblation Catheter System, uses the same approach but employs a balloon that fills with liquid nitrogen to freeze the tissue.

In the new study, called Stop-AF, Dr. Kevin Wheelan of the Baylor Heart and Vascular Hospital in Dallas and his colleagues at 26 U.S. and Canadian centers studied 245 patients with paroxysmal atrial fibrillation, in which the episodes occur intermittently. Two-thirds of the patients were randomized to receive the treatment and the rest received drug therapy. The Johnson & Johnson device had not been approved by the FDA when they began the study, so they had to compare it to the best available approved treatment.

Dr. Douglas Packer of the Mayo Clinic in Rochester, Minn., said at the meeting that 69.9% of the patients receiving cryoablation were free of atrial fibrillation a year after the procedure, compared with 7.3% on drug therapy. About 3% of patients who underwent ablation suffered heart attacks, strokes or other major cardiovascular events, compared with 8.5% of those on drug therapy. The most serious side effect of the procedure was phrenic nerve palsy — an interference with the electrical pacing of the diaphragm — in 11.2% of the procedures. The problem resolved within a year in all but four patients.

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George Allen, Coach Who Built Winners, Dies at 72

George Allen, Coach Who Built Winners, Dies at 72:
Football: Motivator of troubled teams led Rams, Redskins and Cal State Long Beach to victorious seasons.

Los Angeles Times
January 01, 1991|STEPHEN BRAUN | TIMES STAFF WRITER

Football Coach, George AllenGeorge Allen, the steely personification of the victory-obsessed football coach, who motivated underachieving Los Angeles Rams and over-the-hill Washington Redskins teams into perennial powerhouses and came back this year to post one last winning season as coach of the Cal State Long Beach 49ers, died Monday.

Allen, a physical fitness buff who never fulfilled his elusive dream of building a national fitness academy, died of natural causes at his Palos Verdes Estates home. He was 72.The man who coached for six decades had been complaining of a cold, said Perry Moore, a former athletic director at Cal State Long Beach. Allen telephoned Moore about 11:30 Monday morning and they talked for about 20 minutes.

“He was hoarse and he said he had a cold and didn’t feel good,” Moore said. “We talked about football and he said he thought he could get a couple of good kids (recruits) for next year’s team.”

Another report, confirmed by a university official, suggested that a giddy locker-room celebration after the college team’s season-ending victory against the University of Nevada, Las Vegas, might have contributed to Allen’s recent poor health. The coach was doused with ice water by his ecstatic players and ever since had not been feeling well, said Becca Wohlt, a university spokeswoman.

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Dodger’s hope closer Kenley Jansen will return by middle of month

Dodgers Now

STEVE DILBECK AND THE TIMES’ DODGERS REPORTERS
GIVE YOU ALL THE NEWS ON THE BOYS IN BLUE
Dodgers hope closer Kenley Jansen will return by middle of month

By Steve Dilbeck
September 4, 2012, 4:45 p.m.

Kenley Jansen hopes to be pitching again by the middle of the month, though surgery awaits his heart condition.

Jansen hasn’t pitched since Aug. 27 in Colorado, when he once again suffered an irregular heartbeat.

After consulting with another heart specialist Tuesday, the Dodgers announced he would remain on blood thinners another 10 days, and hopes to be able to pitch again by Sept. 17, which is an off day.

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