Long-term suppression of atrial fibrillation by botulinum toxin injection into epicardial fat pads in patients undergoing cardiac surgery: Three-year follow-up of a randomized study
| Autor: | Jonathan S. Steinberg, D. Elesin, Sunny S. Po, Ilya Stenin, Boris N Kozlov, Artem Strelnikov, Dmitry Ponomarev, Sevda Bayramova, Igor Mikheenko, Evgeny Pokushalov, D. S. Sergeevichev, Alexander Romanov, Denis Losik, Vitaliy Shabanov |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Botulinum Toxins Time Factors Neurotoxins 030204 cardiovascular system & hematology Placebo law.invention Injections 03 medical and health sciences Electrocardiography 0302 clinical medicine Randomized controlled trial Double-Blind Method law Heart Rate Physiology (medical) Internal medicine Atrial Fibrillation Preoperative Care Clinical endpoint Medicine Humans 030212 general & internal medicine Prospective Studies Cardiac Surgical Procedures business.industry Incidence (epidemiology) Hazard ratio Atrial fibrillation Middle Aged medicine.disease Botulinum toxin Cardiac surgery Treatment Outcome Adipose Tissue Cardiology Female Cardiology and Cardiovascular Medicine business Pericardium medicine.drug Follow-Up Studies |
| Zdroj: | Heart rhythm. 16(2) |
| ISSN: | 1556-3871 |
| Popis: | Botulinum toxin (BTX) injections into epicardial fat pads in patients undergoing coronary artery bypass grafting (CABG) has resulted in suppression of atrial fibrillation (AF) during the early postoperative period through 1-year of follow-up in a pilot program.The purpose of this study was to report 3-year AF patterns by the use of implantable cardiac monitors (ICMs).Sixty patients with a history of paroxysmal AF and indications for CABG were randomized 1:1 to either BTX or placebo injections into 4 posterior epicardial fat pads. All patients received an ICM with regular follow-up for 3 years after surgery. The primary end point of the extended follow-up period was incidence of any atrial tachyarrhythmia after 30 days of procedure until 36 months on no antiarrhythmic drugs. The secondary end points included clinical events and AF burden.At the end of 36 months, the incidence of any atrial tachyarrhythmia was 23.3% in the BTX group vs 50% in the placebo group (hazard ratio 0.36; 95% confidence interval 0.14-0.88; P = .02). AF burden at 12, 24, and 36 months was significantly lower in the BTX group than in the placebo group: 0.22% vs 1.88% (P = .003), 1.6% vs 9.5% (P.001), and 1.3% vs 6.9% (P = .007), respectively. In the BTX group, 2 patients (7%) were hospitalized during follow-up compared with 10 (33%) in the placebo group (P = .02).Injection of BTX into epicardial fat pads in patients undergoing CABG resulted in a sustained and substantial reduction in atrial tachyarrhythmia incidence and burden during 3-year follow-up, accompanied by reduction in hospitalizations. |
| Databáze: | OpenAIRE |
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