Cardiovascular Business - January/February 2009 - (Page 26)

Clinical Study Digest › By Justine Cadet and C.P. K aiser - In-hospital rapid response teams questioned - Stress CT perfusion compares well to MRI - Women with valve disease misdiagnosed HR: Robotic catheter navigation ablation found safe for common-type atrial flutter In a prospective, randomized study, German researchers demonstrated the safety and feasibility of a robotic navigation system to perform a cavotricuspid isthmus ablation in patients with common-type atrial flutter. As a result of the remote navigation, x-ray exposure and radiofrequency duration to achieve bidirectional block were significantly decreased and occurred more often immediately after atrial flutter termination, according to the study (Heart Rhythm 2008;5:1556–1560). Daniel Steven, MD, and colleagues from the University Hospital Hamburg-Eppendorf said the findings are Hansen sensei robotic navigation system consistent with increased catheter stability and radiofrequency application efficacy using remote navigation compared with conventional catheter manipulation. Researchers randomly assigned 50 patients to conventional or remotely guided ablation. vealed few instances of rapid response team undertreatment or underuse that may have affected the mortality findings. Researchers asked whether recommendations to disseminate rapid response teams nationally are warranted without a demonstrable mortality benefit. HR: Multiple, previous procedures predict complications after ICD replacement Patients with implantable cardioverter defibrillators (ICDs) who have had multiple, previous pocket procedures are at an increased risk of complications after ICD replacement, according to a study in the December edition of Heart Rhythm. Among the 12 participating centers in Canada, Andrew Krahn, MD, and colleagues from the London Health Sciences Center in London, Ontario, found that 451 out of 2,635 advisory ICD devices were replaced. Of the 451 patients who underwent ICD replacement, 41 experienced complications, 27 required reoperation and included two deaths, and 14 patients experienced minor complications. The study proves that multiple, previous pocket procedures are a predictor of ICD replacement complications, Krahn said, adding that the findings will help physicians better understand complication risks for this patient population. JAMA: In-hospital rapid response to cardiac arrest does not reduce deaths Although there is an effort to implement rapid response teams in hospitals throughout the country, they do not result in a reduced rate of cardiopulmonary arrests or deaths, according to researchers from the Mid America Heart Institute and University of Missouri in Kansas City. Paul S. Chan, MD, and colleagues evaluated 24,193 patient admissions prior to the implementation of a rapid response intervention and 24,978 admissions after the intervention (JAMA 2008;300(21):2506-2513). Researchers found that case fatality rates after cardiopulmonary arrest were similar prior to and after the rapid response team intervention (77.9 vs. 76.1 percent). Secondary analyses re- ASN: Coronary revascularization options for kidney disease patients vary Researchers found that stenting patients with coronary disease who also have end-stage renal disease provides the best one-year survival rates. Coronary artery bypass graft (CABG) surgery, however, provided the best long-term survival rates, according to a study presented at the 2008 American Society of Nephrology meeting in Philadelphia. Charles Herzog, MD, and Craig Solid of the Cardiovascular Special Studies Center at the U.S. Renal Data System (USRDS) in Minneapolis, Minn., analyzed data on 13,066 dialysis patients treated with CABG (3,665), bare-metal stents (BMS) (3,237), or drug-eluting stents (DES) (6,164) from 2003 to 2005. The researchers found that DES were associated with the best one-year survival, but long-term survival was best in patients who received bypass surgery. The survival advantage of surgery 26 Cardiovascular Business January/February 2009

Table of Contents Feed for the Digital Edition of Cardiovascular Business - January/February 2009

Cardiovascular Business - January/February 2009 Contents First Word Electrophysiology Roundtable Forum: A Candid Conversation about Profits, Procedures and Patients Heart Failure Care Gets Boost from Technology Emerging Technologies in Peripheral Vascular Interventions Stent vs. Graft: Choosing the Best Path for the Diabetic Patient with Multivessel Disease Cardiology Groups and Hospitals Strive to ‘Connect’ Seamlessly CT Beyond 64 Slices Clinical Study Digest: Kidney Disease & PCI; Women and Valve Disease Compact Echo Systems Come Up Big in Cardiac Care News & Views Reader Resources The ACC Corner

Cardiovascular Business - January/February 2009

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