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Solution A. Nous avons du faire une conversion pour savoir combien de grammes nous mettrons dans nos solutions. Elle se mesure en gramme par litre ou en millimole par litre. Ann Trop Paediatr ; — Ind Heart J ; — Pattern of paediatric blood pressure in rural, semi-urban and urban communities in Ilorin, Nigeria.

Afr J Med Med Sci ; — Blood pressure and adiposity in children and adolescents. A compara-. Waist-to-height ratio and BMI predict different cardiovascular risk factors in Chinese children.

Diabetes Care ; Obesity, body fat distribution, and blood pressure in Nigerian and African-American men and women.

J Natl Med Assoc ; 60— Blood pressure, fatness, and fat patterning among USA adolescents from two ethnic groups. Hypertension ; 4: — Weight threshold and blood pressure in a lean black population. Blood pressure among overweight adolescents from urban school children in Pune, India. Eur J Clin Nutr ; — Abstract Background: Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease.

Despite these facts, no study on the prevalence, awareness, treatment and control on arterial hypertension in Senegal has been conducted, specifically among elderly people. Methods: Five hundred people aged 50 years and older, living in the city of Dakar were interviewed. This sample was constructed using the combined quota method in order to strive for representativeness of the target population. Results: Prevalence of hypertension was The only factor associated with awareness, treatment and control of hypertension was the frequency of doctor visits.

Conclusion: Improving follow-up health checks of older adults are necessary to limit the consequences of hypertension in Dakar.

Cardiovascular disease is an emerging problem in sub-Saharan Africa. Urbanisation and the adoption of a Western lifestyle contribute greatly to the rising incidence of hypertension in sub-Saharan Africa. Whether carried out in Western countries or in sub-Saharan Africa, all studies show that the prevalence of arterial hypertension rises drastically with age and that the elderly are the population segment the most at risk.

Yet, studies carried out in both developed and developing countries demonstrate clear evolution in the prevalence, awareness, treatment and control of hypertension during the aging process.

Methods This study was conducted from January to June on a sample of individuals. The sample was constructed using the quota method cross-section by age, gender and town of residence in order to strive for representativeness of the population 50 years and older living in the city of Dakar. The sample was constructed so as to reflect this proportion and included 12 men 50—59 years old living in this town.

For each town, four investigators PhD students in the departments of Medicine and Pharmacy started out from different points each day to measure and interview individuals in Wolof or French in every third home. Investigators had a set number of individuals to interview women and men 50—59 years, 60—69 years, and 70 years and over in each town to meet the quotas. Only one person was selected as a respondent in each home.

The objective of this bio-anthropological survey was to carry. To do so, faceto-face guided interviews based on a questionnaire were used to collect the data required for the study. These interviews were followed by a physical examination that involved taking blood pressure and anthropometric measurements.

Study definitions and measurements Blood pressure was measured twice for each participant in the course of a single visit. The first measurement was taken mid-way through the interview, just after the questions related to individual health. Following World Health Organisation recommendations, body mass index BMI was calculated by dividing weight kg by the square of the height m2. Among the socio-demographic data collected during the interviews, four variables were taken into account for this study: age, gender, educational level and marital status.

Three age groups were defined: 50—59, 60—69 and 70 years and over. Gender was coded as follows: 1 for women, 0 for men. Three levels of education were defined: none, one to eight years of. Treated Controlled Prevalence, awareness, treatment and control of hypertension in the population of Dakar aged 50 years and older. Statistical analysis To answer our research questions, we used Chi-square tests and logistic regressions.

TABLE 2. The bivariate results were confirmed using logistic regression analysis Table 3. Aside from BMI, using bivariate analyses, all factors studied were associated with awareness of hypertension. Women, the older and unmarried individuals were more often informed of this problem than men, younger people and married individuals.

Likewise, many more individuals who had seen a doctor at least once in the year preceding the interview were aware of their hypertensive condition than those who had not seen a doctor during this period. Lastly, and more surprisingly, people who had had at least nine years of schooling were less often aware of their hypertensive status than the less educated Table 2. Most of these results were controlled using logistic regression analysis and only marital status was not significantly associated with awareness of hypertension Table 3.

Multivariate analysis showed that among hypertensives, women, older adults, and those who had seen a doctor during the preceding year more often reported taking treatment than men, younger people, and those who had not seen a doctor during the previous year, respectively Table 3. The socio-demographic characteristics of our population sample and the descriptive results regarding frequency of doctor visits and BMI are presented in Table 1. Men were better educated and less often overweight or obese than women.

On the other hand, more women had visited a doctor in the year preceding the interview. In our sample, the prevalence of hypertension was However, among people reporting they were treated for hypertension, only These analyses also showed that overweight or obese individuals were more often affected by hypertension than others The results for the sub-sample of individuals who were aware of their hypertension problem were quite different.

In this logistic regression analysis, only the frequency of doctor visits was significantly associated with treatment of hypertension Table 3. Among the hypertensives, on multivariate analysis, only the frequency of doctor visits was associated with control of hypertension Table 3. Therefore, people having seen a doctor during the preceding year more often had controlled hypertension than those who had not seen a doctor the previous year.

However, among treated individuals, no variable was associated with control of hypertension Table 3. Discussion The prevalence of hypertension in our population sample corresponded with that observed among older people in other sub-Saharan African cities or in other developing countries such as India and Bangladesh. In keeping with what has been observed among other populations, aging and problems of overweight and obesity were associated with hypertension. This observation seems to indicate that the Dakar population is currently in an advanced stage of epidemiological transition.

This process is characterised by a transfer of risk factors for chronic illnesses from the bettereducated individuals in the early stages of the process to the less educated at the end of the transition. As with most developing populations, women were more often informed on their problem of hypertension than men.

This might explain both their more frequent visits to these institutions and their greater monitoring of hypertension. Unlike the results noted for elderly German and American populations,18,19 awareness of hypertension rises with age among the elderly in Dakar.

Therefore the probability of having been identified as hypertensive rises with age. More surprisingly, we have seen that people with a higher educational level were often less informed on their hypertension than those with an average educational level.

This result runs contrary to all research conducted on the subject, which generally demonstrates. Nevertheless, it is not surprising to note that the factor most strongly associated with awareness of hypertension was the frequency of doctor visits.

This theoretically encouraging statistic should, however, be discussed in light of the results associated with control of hypertension. A study conducted in Ghana could help explain why the hypertension control rate was so low among the elderly in Dakar.

According to Salem, treatment of chronic disease is generally misunderstood. In Dakar, when a disease is identified, it is believed it should be ejected as a foreign body. Since pharmacological treatment of hypertension is the consequence of its detection by healthcare personnel, factors associated with treatment among hypertensives were the same as those associated with awareness of this health problem, i.

Among these factors, only the frequency of doctor visits was significantly associated with the control of hypertension. Therefore it was the only factor investigated that was associated with awareness, treatment and control of hypertension in this study.

This result highlights the absolute necessity of improving the follow-up health checks of older adults to minimise the consequences of hypertension in Dakar.

Strengths and limitations of the study This research was, to our knowledge, the first study conducted specifically on hypertension among the elderly in sub-Saharan Africa. In years to come, the elderly in developing countries will represent the majority of older people on the planet.

This study has several limitations. As in many studies, arterial blood pressure was measured twice during a single visit, which may have led to overestimation of the prevalence of hypertension.

Furthermore, the treatment rate of hypertension was assessed solely by individual self-reporting. Verification of the actual presence of medication in the home might have limited the bias associated with these declarations. Conclusion The results of this study have several public health implications.

Firstly, two-thirds of the Dakar elderly suffer from hypertension,. Nearly three-quarters of the people informed on their condition reported being treated, which is an encouraging statistic in a developing country.

It is likely that the high cost of pharmacological treatment when compared to income was responsible for the low rate of compliance with these treatments. One of the factors studied was associated with awareness, treatment and control of hypertension: the frequency of doctor visits. This result highlights the absolute necessity to improve follow-up health checks of older adults to minimise the consequences of hypertension in Dakar. The manuscript was translated from French by Cynthia Schoch.

Sani MU. Cardiovascular diseases in sub-Saharan Africa: an emerging problem. Ethn Dis ; — World Health Organisation.

Accessed Global burden of hypertension: analysis of worldwide data. Hypertension in sub-Saharan African populations. Hypertension in sub-Saharan Africa: a systematic review. Agyemang C. Rural and urban differences in blood pressure and hypertension in Ghana, West Africa.

Publ Hlth ; — Amoah AG. Hypertension in Ghana: a cross-sectional community prevalence in greater Accra. Distribution of blood pressure, body mass index and smoking in the urban population of Dar es Salaam, Tanzania, and associations with socioeconomic status. Int J Epidemiol ; — Hypertension ; 77— Hypertension prevalence and care in an urban and rural area of Tanzania. Blood pressure, hypertension and correlates in urbanised workers in Ibandan, Nigeria: a revisit.

J Hum Hypertens ; 23— The prevalence of hypertension in urban and rural Cameroon. Vorster HH. The emergence of cardiovascular disease during urbanisation of Africans. Publ Hlth Nutr ; 5: — Prevalence, awareness, treatment, and control of hypertension among United-States adults Hypertension ; 69— Hypertension study group.

Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentre study. Bull Wld Hlth Organ ; — Prevalence, awareness, and management of hypertension, dyslipidemia, diabetes among United States adults aged 65 and older. Prevalence, treatment, and control of hypertension by sociodemographic factors among the Dutch elderly. Blood Press Monit ; 49— Obesity: Preventing and Managing the Global Epidemic.

Report of the WHO Consultation. WHO: Geneva, The disease burden associated with overweight and obesity. The prevalence of hypertension and its relationship with obesity: results from a national blood pressure survey in Erytrea.

J Hum Hypertens ; 59— Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Marques-Vidal P, Tuomilehto J. Hypertension in developing economies: a review of population-based studies carried out from to Ndiaye S, Ayad M.

Demographic and Health Surveys: Dakar, Association of adult socioeconomic position with hypertension in older people. J Epidemiol Commun Hlth ; 74— Unaffordable drug price: the major cause of non-compliance with hypertension medication in Ghana. J Pharm Pharm Sci ; 7: — Salem G. Paris: Karthala; United Nations. Madrid, avril Abstract Introduction: Morbidity and mortality from diabetes are compounded by associated cardiovascular risk factors.

For this reason, taking care of these risk factors is a public health goal. In this study we evaluated the level of control of cardiovascular risk factors in black Africans with type 2 diabetes in Senegal. Methods: Between March and July , we recruited type 2 diabetes patients from outpatient care in a specialised hospital in Senegal.

Data were collected on a survey form designed for this purpose. An electrocardiogram and laboratory examinations were also performed. The level of control of diabetes and associated cardiovascular risk factors were assessed, as recommended by the American Diabetes Association ADA. Results: A total of type 2 diabetes subjects women were recruited. The average age was The mean duration of diabetes was 6. The average glycaemic level was 1. The average length of patient follow up was 6.

Antihypertensive drugs were prescribed in More than half The low-density lipoprotein LDL cholesterol goal was achieved in Conclusion: This study shows that the prevalence of cardiovascular risk factors is higher among black Africans suffering from type 2 diabetes.

The control of these factors was not optimal in our study. Dans Parmi les patients hypertendus, Diabetes Metab ; — American Diabetes Association. Standards of medical care in diabetes — Dabetes Care ; 33 S1 : S11—S Novembre ; 45 p. Sowers JR, Reed J. J Clin Hypertens ; 2: — American Diabetes Association: Standards of medical care for patients with diabetes mellitus Position Statement. Diabetes Care ; 24 Suppl 1 : S33—S Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers.

Diabetes Care ; — Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes: a nationwide French survey. The author states that amiodarone is not only a prodrug but also has inherent pharmacodynamic effects, just like its metabolite N-desethyamiodarone N-DEA , which he correctly suggests could have even greater pharmacological effects than the parent compound. However, we need to emphasise that even though N-DEA has similar class III antiarrythmic effects, it has faster sodium channel blockade and lower class IV effects than amiodarone.

It therefore reduces alterations of PR and QTC intervals,9 and hence diminishes the anti-arrythmic effects of amiodarone.

Both amiodarone and N-DEA have long half-lives 50 and 60 days, respectively , and at normal therapeutic doses, the relative contribution of either to the anti-arrythmic and overall cardiac electrophysiological effects is not presently known, despite the aforementioned interaction with grapefruit juice.

This, however, does not disqualify amiodarone as a prodrug. The interaction of grapefruit juice with amiodarone is more complicated than previously thought. Even though cases of QT prolongation and torsades de pointes with amiodarone are rare, a case has been reported of a female patient who presented with marked QT prolongation associated with ventricular arrhythmias including torsades de pointes, requiring electrical cardioversion after amiodarone administration, after she had been drinking large quantities of among others grapefruit juice.

We thank the author for pointing out the typing errors in our references. Mullier FO. The grapefruit: an old wine in a new glass. Cardiovasc J Afr ; 22 1 : Cardiovasc J Afr ; — A comparison of the electrophysiologic effects of intravenous and oral amiodarone in the same patient. Acute and chronic effects of amiodarone on ventricular refractoriness intraventricular conduction and ventricular tachycardia induction.

J Am Coll Cardiol ; 7: — Effect of amiodarone on conduction and refractoriness of the His-Purkinje system in the human heart. QT prolongation and the antiarrhythmic efficacy of amiodarone. Pharmacodynamics of intravenous amiodarone in the dog. J Cardiovasc Pharmacol ; 6: — Electrophysiologic effects of amiodarone: experimental and clinical observation relative to serum and tissue drug concentrations. Dramatic inhibition of amiodarone metabolism induced by grapefruit juice.

Br J Clin Pharmacol ; — Plasma amiodarone and desethylamiodarone levels in chronic oral therapy. Circulation ; 64 Suppl IV : Amiodarone pharmacokinetics. Amiodarone and desethylamiodarone elimination kinetics following withdrawal of long-term amiodarone maintenance therapy. Biopharm Drug Dispos ; 6: — Effects of pink grapefruit juice on QT variability in patients with dilated or hypertensive cardiomyopathy and in healthy subjects.

Translational Res ; — The additive effects of active component of grapefruit juice naringenin and antiarrythmic drugs on HERG inhibition. Cardiology ; 3 : — A dangerous fruit juice. Am J Emergency Med ; Abstract Background: We report the first single-centre experience in Africa with the Sensei X robotic navigation system in an unselected subset of patients with atrial fibrillation AF.

Methods: Data were recorded prospectively of all consecutive patients who underwent robotically assisted catheter ablation therapy using the Sensei X robotic navigation system at the Christiaan Barnard Memorial Hospital, Cape Town, South Africa, from July to July Outcomes were defined at one and nine months. The mean procedure, fluoroscopy and ablation times were Both fluoroscopy and procedure times were significantly longer for the first 19 patients compared with the remaining 76 patients The procedural endpoint of the study was successfully achieved in all patients.

Freedom from relapse after 1. There was a learning curve with regard to fluoroscopy and procedure time, after which point reduction in radiation exposure and operator strain, as well as improvement in procedure throughputs were even more pronounced. Atrial fibrillation AF is the most common sustained cardiac rhythm disturbance in the general population.

Hence, it is imperative to advance treatment options available for patients suffering from this condition. Over the past decade, catheter ablation has been proven to be effective in treating various types of arrhythmias. According to the latest guidelines, catheter ablation is indicated in cases of symptomatic arrhythmias refractory to conventional antiarrhythmia therapies.

However, these two seemingly different strategies are converging towards a unified strategy i. Performance of the Sensei X system has been evaluated in American and European studies.

The data of all consecutive symptomatic patients with AF who underwent robotically assisted catheter ablation therapy using the Sensei X robotic navigation system Hansen Medical, Mountain View, CA from July the time of acquisition of the robotic system to July were recorded in an electronic database.

The exclusion criteria were: 1 patients with cardiac dysrhythmia without documented AF, e. Ninety-five patients were finally included. Institutional research board approval was waived for this study. AF types were defined based on the latest European Society of Cardiology ESC guidelines5 as follows: paroxysmal AF is a self-terminating episode that lasts up to seven days; persistent AF either lasts between seven days and one year, or requires termination by cardioversion with drugs or direct current; longstanding persistent AF lasts a year or more.

Screening fluoroscopy time involved the total minutes the X-ray was applied by the operator to visualise the position of devices or set up the system in the patient, using single-plane pulsed fluoroscopy with a rate of seven frames per second, i.

Ablation radiofrequency time was defined as the total minutes the operator used electrical current to ablate the rebel atrial foci. The procedure time was defined as the time between first venipuncture in the operating room and full recovery of the patient from anaesthesia. All patients were instructed not to ingest any solid foods within six hours prior to their procedure. Three-dimensional mapping was performed to facilitate robotically assisted catheter ablation.

In all patients, 3D reconstruction of the corresponding atrial chamber anatomy was performed with either the EnSite NavX system 76 patients or CARTO electro-anatomic mapping system 19 patients. Procedure All procedures were performed under general anaesthesia using propofol and remifentanil. All patients received a bolus of dexamethasone as part of the anesthesia to reduce the incidence. The use of corticosteroids may also be effective for preventing post-ablation recurrence of atrial tachycardia.

A multipolar catheter was placed into the coronary sinus via a 7F sheath in the right femoral vein. An ablation catheter, either a 3. The steerable sheath system SSS was inserted via a 14F sheath in the right femoral vein and advanced manually into the right atrium under fluoroscopic visualisation.

Approximately 0. After placement of the SSS in the inferior right atrium was confirmed, the position of the SSS was registered into the robotic catheter remote-control system. In all patients, one trans-septal puncture was performed under fluoroscopic guidance. In exceptional patients transoesophageal echocardiographic guidance was used to facilitate trans-septal puncture. The trans-septal puncture was performed manually. Through this trans-septal puncture, a long sheath was advanced into the left atrium, and a circular mapping catheter was introduced into the left atrium.

The ablation catheter was robotically guided into the left atrium through the same transseptal puncture site adjacent to the shaft of the circular mapping catheter.

This catheter was used for ablation. Systemic anticoagulation was initiated after the first transseptal puncture with the use of intravenous unfractionated heparin with a target activated clotting time ACT of approximately s. With this configuration, the final set up before initiation of ablation included the following: a robotically controlled steerable sheath housing the ablation catheter this is performed by a physician at the console and a manually controlled circular mapping catheter handled and moved by the same physician at the procedure tableside.

When intra-oesophageal temperature rises were noted, power output was reduced to 20 W. At the end of the procedure, systemic anticoagulation was discontinued and occasionally partially reversed with intravenous protamine before removal of the vascular sheaths.

Ablation Ablation along the pulmonary vein antrum, which encompasses the posterior wall, septal aspect of the right-sided pulmonary veins, and the ridge between the left atrial appendage and left pulmonary veins, was performed with the Artisan robotic system until disappearance of local PV potential, with the endpoint of electrical isolation of all PV antra. After PV isolation was conducted, the circular ablation catheter was withdrawn. If AF persisted after PV isolation, flecainide was administered intravenously up to a maximum of mg unless contraindicated, in which case amiodarone up to a maximum dosage of mg was infused.

If this restored sinus rhythm then no further left atrial ablation was performed. If AF persisted, then mapping for complex fractionated atrial electrograms was performed. If complex fractionation was noted along the coronary sinus musculature, then ablation was performed along the endocardial aspect of the coronary sinus.

If AF organised into a regular tachycardia at any stage during mapping and ablation, then a detailed activation map was constructed and the appropriate ablation was performed to terminate the flutter or focal atrial tachycardia. If AF persisted despite all of these efforts, a direct-current cardioversion was performed.

Ablation along the posterior cavo-tricuspid isthmus was performed in 30 patients with the robotic system in conjunction with the 3. All patients received enoxaparin Clexane 40 mg bd a few hours post procedure until discharge the next day two doses on average.

Follow up The procedural endpoint of the study was whether isolation of all PV or SVC potential foci was successfully achieved, or conversion to manual catheter ablation was needed.

A two-month blanking period was defined in which episodes of AF occurring within that time period were not considered recurrence. Follow up was scheduled at one and six months. A resting ECG was performed in each follow-up visit.

Outside of the scheduled follow ups, additional assessment or investigation was considered if symptoms warranted it. Patients previously on warfarin resumed oral anticoagulation therapy with warfarin the day after the procedure, and oral anticoagulation therapy was continued for at least one month for patients with paroxysmal AF.

Patients with persistent and long-standing persistent AF received a recommendation to take warfarin for at least three months, after which warfarin was discontinued if sinus rhythm was maintained and the CHADS2 score was less than 2.

All of these patients were advised to take aspirin indefinitely. Antiarrhythmic drugs were continued for a one- to three-month period. All patients received esomeprazole Nexium 40 mg daily for one month.

Distribution of the continuous variables was assessed using the Kolmogorov-Smirnov test. To compare normally distributed. Results A total of procedures were performed in the defined period.

Five robotic ablations were redo procedures on patients who had previously undergone robotic ablation in our centre. Ninety-five patients met all the selection criteria and were enrolled in the final analysis. Demographics and baseline clinical characteristics are summarised in Table 1. The procedural endpoint was achieved in all 95 patients enrolled in the study. All ablation procedures were performed using the Sensei X robotic navigation system. Both fluoroscopy screening and procedure times were significantly longer for the first 19 patients compared with the remaining 76 patients Fluoroscopy time showed a significant decrescendo trend for the first half of the patients, with an R2 of 0.

Dysrhythmia Atrial fibrillation paroxysmal persistent long-standing persistent Atrial flutter typical atypical left atrial peri-mitral. Error bars representing screening time, radiofrequency time and procedure time for subgroups of 19 patients; CI, confidence interval.

Scatter plot showing a decrescendo trend in screening time for the first half of the study group. There were four minor complications. Septicaemia was suspected in one case, which was probably co-incidental and was controlled with antibiotic therapy and supportive measures.

There were two intermediate-level complications. One patient developed a groin arteriovenous fistula, which was related to the large 14F sheath and was repaired surgically. One patient had lateonset pericardial effusion on postoperative day 10 , which was.

There were three major complications. One patient had cardiac tamponade, treated immediately with pericardiocentesis. The patient was female and rather small in size. Another patient had left atrial perforation, which was repaired surgically. Similarly, the patient was female and rather small in size. One patient had aspiration pneumonia and blurring in the right eye due to embolus; his vision recovered after two months. This complication occurred because the patient was morbidly obese kg and it was difficult to keep his ACT above s; he seemed resistant to unfractionated heparin.

No case of pulmonary vein stenosis, transient ischaemic attack or stroke was reported throughout the post-procedure follow up.

Follow up for relapse As of March , patients were followed up for an average of A freedom from AF of One patient refused to undergo more attempts after developing relapse, and four patients 4. Five patients 5. However, one patient died of prostate cancer seven months post ablation. After one attempt, 26 patients Considering those patients who relieved completely after a redo procedure within the nine months post ablation, freedom from relapse rose to Multivariate logistic regression analysis showed that longerstanding types of AF and ablation radiofrequency time are independent predictors of arrhythmia relapse within the ninemonth period post ablation therapy Table 4.

Discussion This is the first report on mid-term efficacy of robotically navigated catheter ablation in an unselected subset of patients with predominantly persistent AF. The overall mid-term success rate of Recently, an updated worldwide survey on the methods, efficacy and safety of manual catheter ablation for AF showed that across all surveyed centres, median overall success rates were For the main subset of patients in this study i.

Given that robotic ablation technology, techniques and catheters are still in their infancy, the efficacy of this treatment modality has the potential to reliably surpass its manual counterpart in the near future. As shown by the multivariate analysis, longer-standing types of AF and ablation radiofrequency time are independent predictors of arrhythmia relapse within the nine-month period post ablation therapy Table 3.

As described in the methods section, some of the more complex cases required ablation along the endocardial aspect of the coronary sinus or in an attempt to terminate the flutter or focal atrial tachycardia in addition to the standard PV isolation. Therefore, longer ablation time in fact points to a more complex underlying arrhythmia circuitry, which is the most likely explanation for its correlation with higher frequency of relapse.

Association of long-standing AF type with higher relapse rate may also be related to the same aetiology. In general, because the robotic navigation system significantly reduces physical operator strain, mitigates concerns over excessive radiation exposure during complex cases, and enables operators to perform complex ablation patterns regardless of catheter skills, operators are more likely to take on more complex and challenging AF cases. Hence, we expect to see longer ablation times as a surrogate for more complex cases associated with higher relapse rates in future studies.

As shown in Fig. This observation was in line with the results reported by Di Biase et al. Reduction in procedure time allows for shorter cases, less physical operator strain and higher laboratory throughput. Lastly, the smaller size of the new Lynx catheter will significantly reduce the risk of minor complications such as groin haematoma or meralgia paresthetica.

It is important to note that despite our modified post-ablation anticoagulation regimen, which differs substantially from the international guidelines due to poor patient compliance with anticoagulation on warfarin and INR testing, no case of transient ischaemic attack or stroke was reported in the median ninemonth post-ablation period. Physicians who care for similar types of patients in areas where compliance is an issue may find our modifications to the standard post-ablation anticoagulation regimen helpful.

The main limitations of this study are the fact that it lacked a matched control group with manual ablation and that there were relatively few subjects in the paroxysmal and long-standing persistent AF groups. Furthermore, some of the therapeutic modifications presented in this article, mainly the modified post-ablation anticoagulation regimen, were based on clinical experience and characteristics of our specific patient population and are not in conformity with international guidelines.

Hence, we do not propose that our methods be adopted by other centres. As a real-world study, we were treating symptomatic patients, with the main clinical endpoint being relief of symptoms. Nevertheless, we believe that the safety and mid-term efficacy results of this study may provide valuable insights for the daily practice of medicine.

Its efficacy in patients with persistent AF is encouraging. Its overall success rate is comparable to manual techniques and impressive for a treatment approach that is relatively in its infancy.

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