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1. Catheter ablation superior to standard drug therapy for heart failure
A meta-analysis of randomized controlled trials found that catheter ablation was superior to conventional drug therapy alone for patients with atrial fibrillation and heart failure. Findings are published in Annals of Internal Medicine.
Atrial fibrillation is associated with thromboembolic stroke, systemic embolism, and decompensated heart failure. Catheter ablation is an established therapeutic strategy for atrial fibrillation, but guidelines recommend caution in certain patients. The benefits and harms of catheter ablation versus drug therapy for patients with atrial fibrillation have not been firmly established.
Researchers from Icahn School of Medicine at Mount Sinai reviewed six published randomized controlled trials to compare the benefits and harms between catheter ablation and standard drug therapy (rate or rhythm control medications) in adult patients with atrial fibrillation and heart failure. Their analysis showed that compared to medication, catheter ablation was associated with reductions in all-cause mortality and heart failure hospitalizations and improvements in left ventricular ejection fraction; quality of life; cardiopulmonary exercise capacity; and 6-minute walk test distance, with no statistically significant increase in serious adverse events.
The major adverse events rates observed in the pooled analysis were 7.2 percent in the ablation group and 3.8 percent in the standard therapy group. Despite the complications associated with catheter ablation, the authors explain that the long-term benefits in all-cause mortality, heart failure hospitalizations, and overall clinical outcomes must be weighed in clinical decision making.
2. Proposed technique prevents confused patients from dislodging central line
A proposed technique for placing a central venous catheter that may prevent confused patients from pulling it out or dislodging it easily. Findings from a case report are published in Annals of Internal Medicine.
Sometimes patients, particularly confused patients, dislodge or pull out central venous catheters inadvertently or intentionally. Although this occurrence is uncommon, it is not rare, and it may have negative consequences.
Physicians from Beth Israel Deaconess Medical Center and Harvard Medical School saw a 77-year-old patient with waxing and waning mental status who required dialysis for chronic kidney failure. The patient became confused and repeatedly pulled out his hemodialysis catheters. Since he was unsuitable for an arteriovenous access and the medical literature offered no solution, the physicians developed a novel technique. They placed a right external jugular vein catheter, tunneling subcutaneously to exit from the patient’s upper back, near the midline, just below his neck. It was out of reach to the patient, but not in an area where it would cause pressure on his skin when he was lying on his back. It worked well enough that the authors suggest clinicians consider this placement when caring for patients at risk for central line dislodgement.