Pulmonary vein isolation for atrial fibrillation: Does ablation technique influence outcome?

BACKGROUND: Over the last 20 years various techniques have been developed striving for safer and more durable pulmonary vein isolation (PVI). The three most commonly used tools are pulmonary vein ablation catheter (PVAC) and cryoballoon ('single-shot' techniques), and point-by-point (PBP) radiofrequency ablation using 3D electroanatomical mapping (EAM). OBJECTIVE: Evaluate the safety and efficacy of the different techniques in an unselected population undergoing de-novo ablation for persistent or paroxysmal atrial fibrillation (AF) at Royal Papworth Hospital (RPH). METHOD: Retrospective, single-centre study of consecutive AF ablations at RPH between March 2017 and April 2018. Demographic, procedural and outcome data were analysed. RESULTS: Over the study period 329 first-time PVI procedures were performed. 37.4% were performed using PBP, 39.8% using cryoballoon and 22.8% using PVAC. There was no significant difference in age or sex between different ablation technique groups. 238 procedures were performed for paroxysmal AF and 91 for persistent AF. A higher proportion of the persistent cases were performed using point-by-point techniques compared to paroxysmal cases (58.2% vs 29.0%, p < 0.05). Procedural times were significantly longer in the group undergoing PBP ablation compared to cryoballoon or PVAC. However, there was no statistically significant difference in 12-month freedom from symptomatic AF or procedural complications between the groups. CONCLUSIONS: PBP, PVAC and cryoballoon AF ablation all appeared equally efficacious in an unselected population, though PVAC and cryoballoon procedures were shorter. All procedures were associated with a low adverse event rate. Prospective examination is required to substantiate this finding.

The assessment and management of post-operative pain in children by registered sick children's nurses: an exploratory study.

In a small exploratory study, convenience samples of registered sick children's nurses (RSCNs), parents and children were interviewed to establish their perceptions of post-operative pain assessment and management. Many of the findings of previous researchers were confirmed. Nurses and parents made judgements of pain using behavioural cues. The administration of analgesia depended on the nurse's personal interpretation of the prescription. The efficacy of analgesia was influenced by the organization of nursing care.

Holiday travel and morbidity reported to general practitioners.

AIM: This study set out to explore the influence that holiday travel might have on the rate at which new episodes of illness are reported to general practitioners. METHOD: The study was carried out in a semi-rural practice of five doctors in Wiltshire in 1989. Details of patients' holiday travel were determined by postal questionnaire. Sociodemographic and clinical data were obtained from the patients' medical records. RESULTS: The response rate to the questionnaire was 85%. The study subjects were divided into those who had taken their holiday abroad (n = 643), those who had taken their holiday in the United Kingdom (n = 973), and those who had taken no holiday (n = 668) during the study year. Interim assessment of clinical results revealed no changes in morbidity indices in relation to holiday intervals in any of the groups except for an apparent rise in the number of new episodes of illness presented in the month before departure by those about to go abroad. Further analysis showed that this was due to a significant 112% increase in the number of episodes of illness presented by this study group in the week before they left home. CONCLUSION: This study suggests that the present focus on the supposed excess morbidity of patients returning from foreign holidays is misplaced.

A concept for all the family. Family centred care: a concept analysis.

Family centred care is now perceived as fundamental to meeting hospitalised children's physical and emotional needs. It is important, however, that nurses fully understand the concept or it may be implemented more with the intention of meeting ward goals than family needs.

The nature of unemployment morbidity. 1. Recognition.

The case records of one group practice have been used as the data base for a longitudinal, controlled study of unemployment and health. Previous numerical analyses have shown increases in reported morbidity in families threatened with and experiencing unemployment. The illnesses reported have now been classified by diagnostic category. The illnesses normally most prevalant were presented less frequently when patients' jobs were insecure and lost, contradicting the suggestion that excess morbidity reported by the unemployed results only from lowered symptom tolerance. On reassembling the data according to the number of consultations per episode a genuine unemployment morbidity was indicated. After job loss among the male employees there was a significant increase in the number of episodes for which there were four or more consultations. It is postulated that unemployment leads to chronic ill health.

The nature of unemployment morbidity. 2. Description.

A longitudinal, controlled study on job loss and health using general practice records has concluded that unemployment morbidity among men made redundant can be identified as an increase in those episodes of illness which are associated with many consultations. The possibility that these episodes represent chronic ill health has been tested using the same data base. If chronic illnesses are defined as those requiring active management after one year, their incidence among unemployed men was over six times that among controls (P<0.001). Cardiovascular disorders were frequently detected in the unemployed men and several of the other chronic complaints they suffered may also have had a psychosomatic aetiology related to stress. The consequent workload in terms of consultations, investigations, referrals, outpatient attendances and drug therapy increased significantly after job loss. More frequent, short-lived illnesses showed continuing downward trends in study and control men.The results suggest that unskilled men face a serious health hazard if made redundant. Investigating and treating their chronic disabilities leads to an increased medical workload and must further burden the health service.

Certificated sickness absence in industrial employees threatened with redundancy.

The proposition that workers take less sick leave when threatened by redundancy was examined in a longitudinal, controlled study using information from case records in a general practice. The hypothesis was only partly supported--certificated sickness absence dropped only in employees under the age of 40. Workers fearing job loss reported more illness, and their periods of absence were significantly longer, especially for men and for workers who had previously consulted their general practitioner infrequently. This study provides further evidence that the fear of mass redundancy is stressful to workers so threatened and costly to a society experiencing rising unemployment.

[The health of industrial employees four years after compulsory redundancy].

A controlled, longitudinal study of the health of workers made redundant when a meat products factory closed has been performed using morbidity data extracted from the records of a group general practice. Increases in consultation rates and the number of visits to hospital outpatient departments in the group made redundant are contrasted with opposite trends in a control group who remained securely employed. As in earlier findings, the increases in morbidity in the study group began when they learned that their jobs were in jeopardy.The subsequent employment history of those made redundant was obtained by questionnaire. In the four years after redundancy, 50 of the 76 men in-the study group found new full-time jobs. The other 26 men remained out of work for most of this time or were made redundant once again. This 'jobless' group consulted their general practitioners 57% more often about 13% more illnesses, were referred to hospital outpatient departments 63% more often and visited hospital 208% more frequently than when enjoying secure employment. During an intervening two-year period of job insecurity, there were increases of 45%, 9%, 25% and 28% respectively, for this jobless group.The implications of these findings for primary care, for the National Health Service and for future research are discussed in the present context of high levels of unemployment.

Job-loss and morbidity in married men with and without young children.

The data resulting from a longitudinal study of the consequences of threatened and eventual job-loss on health in industrial employees was examined in order to analyse the influence of family size. When the risk factor of age was eliminated, no difference was found in the use made of health services by married men with at least two dependent children aged under 16 years and those with no dependent children. However, the wives of men with no dependent children consulted at a significantly higher rate than the wives of men with dependent children in the period when their husbands faced and then underwent job-loss.

Job-loss and morbidity: the influence of job-tenure and previous work history.

As part of a longitudinal study on the consequences of job-loss on health the modifying influence of job-tenure on a group of factory workers made redundant when a meat products factory closed was examined. The older workers, both men and women, were divided into two groups which were comparable in all respects except for job-tenure. Statistically significant differences in morbidity were found when comparing the two groups of male employees and their families.However, the men with longer job-tenure (mean 30 years) had, with few exceptions, served the company since leaving school. All of the other men (mean job-tenure 11 years) had previously worked elsewhere or been unemployed. The uptake of medical services before and after factory closure was therefore compared in two groups of workers and their families. One group who had previous experience of the job market showed a significant rise in morbidity only during the unsettling three years before factory closure. The other group, whose working lives had been spent wholly with the company, showed only a slight anticipatory effect but then demonstrated statistically significant increases in consultation rates after job-loss. Three years later they still showed no signs of adapting to their situation.The results suggest that previous experience of having no job or of having to change jobs may be just as influential as job tenure on the outcome of health before and after compulsory redundancy.

Job-loss and health--the influence of age and previous morbidity.

Analysis of data on morbidity in a group of factory workers shows a significant increase when these workers are threatened with and subsequently made redundant. The influence of increasing age and of low prior morbidity are shown to be detrimental to the health of both male and female employees. When these risk factors are combined these employees show a 150% increase in the number of consultations, a 70% increase in the number of episodes of illness, a 160% increase in the number of referrals to hospital outpatient departments and a 200% increase in the number of attendances at outpatient departments.These changes occur two years before actual job-loss when the workers learn that their employee is in financial difficulty and their jobs are in jeopardy.It is suggested that older employees demonstrate greater stress because of their poor re-employment prospects and reduced adaptability. It is also suggested that existing differences in consulting tendency might represent differing levels of work attachment among the employees - the low consulters being most strongly oriented towards their jobs and therefore suffering the greater loss when made redundant.

Job-loss and morbidity in a group of employees nearing retirement age.

As part of a study of the morbidity of a group of workers made redundant from a meat products factory, the health of employees nearing retirement has been investigated. Consultations, episodes of illness and referrals to and attendances at hospital outpatient departments were recorded annually as the indices of morbidity. With the threat of redundancy a significant increase in morbidity was noted for the male employees but not for the female employees. It is suggested that these men adapt less easily to redundancy than the women.

Job-loss and family morbidity: a study of a factory closure.

A controlled, longitudinal study was performed to investigate the consequences of unemployment on health. A significant increase in morbidity was demonstrated in the families of 129 workers (80 men and 49 women) made redundant when a factory manufacturing meat products closed. A significant increase was also found when the employees themselves were studied as a separate group. The decline in health began when, two years prior to job-loss, the management intimated that production might have to cease. In the four years after this news, consultation rates in the study group showed a highly significant increase. Both referrals to and attendances at hospital outpatient departments also increased significantly. The results suggest that the threat of redundancy is a stress which is equal to, if not greater than, the actual event. Extrapolation from these findings implies an increase in work-load and cost for the National Health Service directly attributable to a rising unemployment rate.