In other news: Binge drinking and AF; Blueprint to end RHD; Practice makes perfect when it comes to carotid stenting

On the beers: why binge drinking triggers AF

Cardiologists at the Alfred Hospital Melbourne have elucidated a mechanism that may explain why binge drinking is a common atrial fibrillation (AF) trigger: sympathetic activation followed by a ‘rebound’ parasympathetic response.

They recruited 50 people with a history of binge drinking (more than five standard drinks per session) to undergo cardiac MRI and rhythm monitoring, of whom 20 had a history of AF. They found that mean heart rate increased from by eight beats per minute while drinking, but reduced during the hangover period. The hangover period was also characterised by higher daily atrial ectopic count (50 vs baseline 43) and reduced heart rate variability. There was evidence of heightened parasympathetic activity post-hangover with heart rate slowing. Cardiac MRI at around three days post-binge showed a decrease in left atrial (LA) emptying fraction. Three patients developed AF at between 11 and 34 hours post-binge.

Dr Aleksandr Voskoboinik and colleagues concluded that AF may be precipitated by the adverse effects on autonomic function for up to 48 hours after binge drinking and atrial mechanical dysfunction.

Blueprint to eliminate Rheumatic Heart Disease

A comprehensive, evidence-based plan to eliminate rheumatic heart disease (RHD) across Australia by 2031 has been launched, but now needs funding.

Released by the End Rheumatic Heart Disease Centre of Research Excellence in Perth, the strategy blueprint has been developed with the participation of leading experts from 16 institutions across Australia and the input from communities, clinicians, Aboriginal Community Controlled Health Organisations,

The RHD Endgame Strategy: the blueprint to eliminate rheumatic heart disease in Australia by 2031, has been five years in the making, according to senior author Professor Jonathan Carapetis, Director of the Telethon Kids Institute.

According to Professor Carapetis, more than 5,000 Aboriginal and Torres Strait Islander people are living with RHD or acute rheumatic fever, and this number will more than double in the next decade without implementation of the plan. Of these people, 650 will likely die and 1,300 will need open heart surgery.

“It really is unconscionable to let the next generation of our children develop this disease – to be subjected to heart surgery, a needle every month, and have their life expectancy limited by decades – when we know how to stop this,” said Professor Carapetis.

But without investment, the Commonwealth Government was unlikely to meet its commitment to eliminate the disease by 2031, he said.

Practice makes perfect when it comes to carotid stenting: Audit

Higher perioperative complication rates are seen in cardiac surgery operators with low caseload volumes for carotid endarterectomy and carotid artery stenting an Australian study has shown.

Data from the Australasian Vascular Audit showed that operators with the lowest annual caseload volume had 28% higher stroke and death rates compared to higher volume centres (2.21% vs 1.76%) for carotid endarterectomy. Carotid artery stenting procedures showed six times higher complication rates for lower-volume operators (2.63% vs 0.37%).

The authors of the study said suggested that minimum operator thresholds, restructuring of services and networked referral pathways of care should be considered to improve patient outcomes.

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