Cardiol J
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Review Meta Analysis
Systematic review and meta-analysis of chronic kidney disease as predictor of atrial fibrillation recurrence following catheter ablation.
Recent observational studies have shown that patients with chronic kidney disease (CKD) have higher risk of atrial fibrillation (AF) recurrence and, therefore, the value of catheter ablation therapy in patients with CKD has been doubted. The purpose of this meta-analysis was to systematically analyze the effect of CKD on recurrence of AF following catheter ablation. ⋯ CKD was associated with higher AF recurrence rate following single catheter ablation. In addition, patients with 100% paroxysmal AF have higher risk than patients with non 100% paroxysmal AF that merits special consideration when evaluating patients for catheter-based AF ablation. Given that the CKD prevalence is rapidly increasing, there is an imperative need for better risk stratification of catheter ablation candidates.
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Syncope is a common and challenging presenting complaint to the Emergency Department (ED). Despite substantial research efforts, there is still considerable uncertainty about the optimal ED management of syncope. There is continued interest among clinicians and researchers in improving diagnostic algorithms and optimizing resource utilization. ⋯ For appropriate patients with a negative ED evaluation, we recommend consideration of direct discharge, with ambulatory monitoring and expedited follow-up, as a means of decreasing costs and reducing iatrogenic harms. Finally, we advocate for the use of shared decision-making regarding the ultimate disposition of select, intermediate risk patients who have not had a serious condition revealed in the ED. If properly implemented, these four strategies could significantly improve the care of ED syncope patients by helping clinicians identify truly high-risk patients, decreasing unnecessary hospitalizations, and increasing patient satisfaction.
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The purpose of this review was to summarize the up-to-date knowledge on clinical presentation and management of neurocardiogenic injury and to deliver the evidence of common pathophysiology of this broad spectrum of disorders. ⋯ Neurocardiogenic injury should be carefully differentiated from AMI. Cardiac dysfunction in SAH heralds increased mortality. The criteria for the diagnosis of stress cardiomyopathy should be revised to comprise the diversity of its clinical symptomatology and to include cardiac dysfunction accompanying cerebral pathology.