Tuesday, October 12, 2010
atrium fibrillation AF
Freelance writer and reviewer, Medscape, LLC
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Sarah Fleischman
CME Program Manager, Medscape, LLC
Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the efficacy of catheter ablation in patients younger than 45 years with atrial fibrillation, based on a large observational study.
2. Describe the risks associated with catheter ablation in patients younger than 45 years with atrial fibrillation, based on a large observational study.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.
This activity, MedscapeCME Clinical Briefs has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2010. Term of approval is for 1 year from this date. Each issue is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of this issue.
Note: Total credit is subject to change based on topic selection and article length.
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
AAFP Accreditation Questions
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME Released: 09/28/2010; Valid for credit through 09/28/2011
Instructions for Participation and Credit
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
1. Read the target audience, learning objectives, and author disclosures.
2. Study the educational content online or printed out.
3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
Hardware/Software Requirements
MedscapeCME is accessible using the following browsers: Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash, Adobe Acrobat, or Microsoft PowerPoint.
September 28, 2010 — A new study suggests that ablation may be the best choice for the first therapy for atrial fibrillation (AF) in younger patients [1].
Researchers led by Dr Peter Leong-Sit (London Health Science Hospital, ON) collected data from 1548 consecutive patients with drug-refractory AF who underwent 2038 AF ablation procedures over an eight-year period in the University of Pennsylvania Health System. They compared the outcomes of four age groups: <45 years, 45 to 54 years, 55 to 64 years, and >65 years. Results of the study are published online September 21, 2010 in Circulation: Arrhythmia & Electrophysiology.
The primary outcome, AF control, defined as no or rare AF on or off antiarrhythmic drugs, was similar in all groups (p=0.06). AF control was achieved in 87% of the youngest patients, 82% of the oldest patients, and 88% of both of the middle-aged groups. However, more patients younger than 45 demonstrated freedom from AF off of antiarrhythmic drugs (76%) compared with the 45-to-54-year-old group (68%), the 55-to-64-year-old group (65%), or the over-65 group (53%) (p<0.001).
There were zero major complications in the patients younger than 45, but 10 major complications in the oldest (2.6%) group. There were 10 (1.7%) and 14 (1.4%) major complications in the 45- to 54-year-olds and 55- to 64-year-olds, respectively (p=0.01)
Previous studies show that younger patients with atrial fibrillation tend to be more symptomatic than older AF patients, but they are less compliant with long-term medications than their older counterparts. However, catheter ablation remains recommended as only second-line therapy for AF regardless of age, Leong-Sit and colleagues point out. The 2006 American College of Cardiology/American Heart Association/European Society of Cardiology guidelines on AF recommend ablation as a second-line therapy, and the 2007 Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society expert consensus statement on AF ablation states that catheter ablation may be appropriate as a first-line therapy only in rare clinical situations.
Prior to this study, there were little data on the efficacy and risks of catheter ablation for AF in young patients, according to the authors. The new data at least demonstrate the feasibility of ablation instead of drugs as the first-line therapy in younger AF patients. "These data are strongly suggestive that ablation should be considered as a first-line strategy in young patients and reinforce the need for a randomized-controlled trial of first-line ablation vs antiarrhythmic medication in this young age group," the authors argue.
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Sarah Fleischman
CME Program Manager, Medscape, LLC
Disclosure: Sarah Fleischman has disclosed no relevant financial relationships.
Learning Objectives
Upon completion of this activity, participants will be able to:
1. Describe the efficacy of catheter ablation in patients younger than 45 years with atrial fibrillation, based on a large observational study.
2. Describe the risks associated with catheter ablation in patients younger than 45 years with atrial fibrillation, based on a large observational study.
Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™
Family Physicians - maximum of 0.25 AAFP Prescribed credit(s)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.
Accreditation Statements
For Physicians
Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
Medscape, LLC designates this educational activity for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.
This activity, MedscapeCME Clinical Briefs has been reviewed and is acceptable for up to 300 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins September 1, 2010. Term of approval is for 1 year from this date. Each issue is approved for .25 Prescribed credits. Credit may be claimed for 1 year from the date of this issue.
Note: Total credit is subject to change based on topic selection and article length.
Medscape, LLC staff have disclosed that they have no relevant financial relationships.
AAFP Accreditation Questions
Contact This Provider
For questions regarding the content of this activity, contact the accredited provider for this CME/CE activity noted above. For technical assistance, contact CME@medscape.net
CME Released: 09/28/2010; Valid for credit through 09/28/2011
Instructions for Participation and Credit
There are no fees for participating in or receiving credit for this online educational activity. For information on applicability and acceptance of continuing education credit for this activity, please consult your professional licensing board.
This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page.
Follow these steps to earn CME/CE credit*:
1. Read the target audience, learning objectives, and author disclosures.
2. Study the educational content online or printed out.
3. Online, choose the best answer to each test question. To receive a certificate, you must receive a passing score as designated at the top of the test. MedscapeCME encourages you to complete the Activity Evaluation to provide feedback for future programming.
You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates by accessing "Edit Your Profile" at the top of your Medscape homepage.
*The credit that you receive is based on your user profile.
Hardware/Software Requirements
MedscapeCME is accessible using the following browsers: Internet Explorer 6.x or higher, Firefox 2.x or higher, Safari 2.x or higher. Certain educational activities may require additional software to view multimedia, presentation or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Macromedia Flash, Adobe Acrobat, or Microsoft PowerPoint.
September 28, 2010 — A new study suggests that ablation may be the best choice for the first therapy for atrial fibrillation (AF) in younger patients [1].
Researchers led by Dr Peter Leong-Sit (London Health Science Hospital, ON) collected data from 1548 consecutive patients with drug-refractory AF who underwent 2038 AF ablation procedures over an eight-year period in the University of Pennsylvania Health System. They compared the outcomes of four age groups: <45 years, 45 to 54 years, 55 to 64 years, and >65 years. Results of the study are published online September 21, 2010 in Circulation: Arrhythmia & Electrophysiology.
The primary outcome, AF control, defined as no or rare AF on or off antiarrhythmic drugs, was similar in all groups (p=0.06). AF control was achieved in 87% of the youngest patients, 82% of the oldest patients, and 88% of both of the middle-aged groups. However, more patients younger than 45 demonstrated freedom from AF off of antiarrhythmic drugs (76%) compared with the 45-to-54-year-old group (68%), the 55-to-64-year-old group (65%), or the over-65 group (53%) (p<0.001).
There were zero major complications in the patients younger than 45, but 10 major complications in the oldest (2.6%) group. There were 10 (1.7%) and 14 (1.4%) major complications in the 45- to 54-year-olds and 55- to 64-year-olds, respectively (p=0.01)
Previous studies show that younger patients with atrial fibrillation tend to be more symptomatic than older AF patients, but they are less compliant with long-term medications than their older counterparts. However, catheter ablation remains recommended as only second-line therapy for AF regardless of age, Leong-Sit and colleagues point out. The 2006 American College of Cardiology/American Heart Association/European Society of Cardiology guidelines on AF recommend ablation as a second-line therapy, and the 2007 Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society expert consensus statement on AF ablation states that catheter ablation may be appropriate as a first-line therapy only in rare clinical situations.
Prior to this study, there were little data on the efficacy and risks of catheter ablation for AF in young patients, according to the authors. The new data at least demonstrate the feasibility of ablation instead of drugs as the first-line therapy in younger AF patients. "These data are strongly suggestive that ablation should be considered as a first-line strategy in young patients and reinforce the need for a randomized-controlled trial of first-line ablation vs antiarrhythmic medication in this young age group," the authors argue.
# posted by roodbont @ 4:30 AM 
