Re: NICE AF Guideline - your chance to make comments!

[Guest guest]

> Hello all, especially readers in the UK

>

> I'm surprised that nobody has commented on this yet. I have printed

> out the short version of the guideline and skimmed through the full

> version.

>

> The deadline for comments is 10 November and I am planning to put in

> some comments to NICE. My first impression is that the guideline is

> almost entirely focussed on treating the symptoms of AFib with very

> little consideration being given to treatment of the underlying

> causes. Furthermore, the little stuff there is on underlying causes

> is mostly the usual stuff about alcohol and caffeine.

>

> There are some particular areas I want to comment on and I'm asking

> for everyone's help to point me to any scientific references that I

> can quote in the following subject areas:

Hi Mark - I ploughed into the long version but confess I didn't get to

the end (match sticks under the eye lids are required I'll try to

finish it off this weekend. I haven't commented yet because so far I

haven't found anything to comment on

> 1. Afib in conditioned athletes - are there any scientific papers on

> this apart from the Karjaleinen study of Scandinavian orienteers?

try some searches at Pub med e.g. for 'atrial fibrillation athlete'

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search & DB=pubmed

There's was a recent one suggesting no connection....

Prevalence and clinical significance of left atrial remodeling in

competitive athletes.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16098437 & query_hl=4

> 2. Using exercise to revert to NSR - are there any scientific papers

> or just anecdotal evidence?

I don't recall reading any but you'll find loads referring to how AERP

(Atrial effective refractory period) influences AF. Exercise is just one

of the ways to mess with this variable.

>

> 3. Dehydration and/or electrolyte depletion as triggers for AFib -

> again are there any scientific papers or just anecdotal evidence?

not sure about the dehydration but you'll find some mention of electrolytes

(also search PubMed/Google for 'exhausted horse syndrome')

> 4. Work and emotional stress as triggers for AFib - again are there

> any scientific papers or just anecdotal evidence?

again, PubMed is the place to go, you should find these and more...

The relationship between personality, socio-economic factors, acute life

stress and the development, spontaneous conversion and recurrences of

acute lone atrial fibrillation.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15878557 & query_hl=14

Arrhythmia-provoking factors and symptoms at the onset of paroxysmal

atrial fibrillation: a study based on interviews with 100 patients

seeking hospital assistance.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=15291967 & query_hl=14

> Thanks in advance to anyone who can help.

>

> Mark

>

If you want to find any free full text articles start your search

here...

http://www.ncbi.nlm.nih.gov:80/gquery/gquery.fcgi

then click on the numbers next to these two..

PubMed: biomedical literature citations and abstracts

PubMed Central: free, full text journal articles

Hope this helps

--

D

[Guest guest]

Thanks for that link Mark. I intend to comment too.

My first reaction is that there is no reference to ablation as a

treatment option (I find this very worrying). Is it that this doc is

not concerned with surgical procedures but with treatment short of

that?

Also no mention of Adrenalin Malfunction as cause.

Your points are very good. It (the document) does seem rather out of

date to me.

> >

> > The government agency in the UK responsible for treatment and

> > prescribing policy accross the National Health Serivce has just

> > released its guideline for AF on its website for public

> consultation.

> > If you want to have your say on this very important document

which

> will

> > determine how patients with AF are treated throughout England

and

> > elsewhere, you can download it at

http://www.nice.org.uk/page.aspx?

> > o=275104, where you can also download the form you need to

submit

> > comments. These comments will eventually find their way back to

me

> and

> > I will discuss all comments with a team of patient reps,

> cardiologists

> > and general physicians to see whether any further changes are

> needed to

> > any part of the guideline. We will be very grateful,

particularly

> from

> > patients with AF or their families, for any comments that are

> made, and

> > will respond to each one individually. Thanks.

> >

>

[Guest guest]

Mark,

I see no reference to ablations in the UK. I recently listened to a BBC

programme where the Medical advisor suggested that ablations were not tried

and tested procedure and caution should be given anyone going for this types

of treatments.

Why is the uk lagging behind on this as the French and the USA going for

gold with ablations.

I also see no reference to Dofetilide.

C

Re: Re: NICE AF Guideline - your chance to

makecomments!

> Hello all, especially readers in the UK

>

> I'm surprised that nobody has commented on this yet. I have printed

> out the short version of the guideline and skimmed through the full

> version.

>

> The deadline for comments is 10 November and I am planning to put in

> some comments to NICE. My first impression is that the guideline is

> almost entirely focussed on treating the symptoms of AFib with very

> little consideration being given to treatment of the underlying

> causes. Furthermore, the little stuff there is on underlying causes

> is mostly the usual stuff about alcohol and caffeine.

>

> There are some particular areas I want to comment on and I'm asking

> for everyone's help to point me to any scientific references that I

> can quote in the following subject areas:

Hi Mark - I ploughed into the long version but confess I didn't get to

the end (match sticks under the eye lids are required I'll try to

finish it off this weekend. I haven't commented yet because so far I

haven't found anything to comment on

> 1. Afib in conditioned athletes - are there any scientific papers on

> this apart from the Karjaleinen study of Scandinavian orienteers?

try some searches at Pub med e.g. for 'atrial fibrillation athlete'

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=search & DB=pubmed

There's was a recent one suggesting no connection....

Prevalence and clinical significance of left atrial remodeling in

competitive athletes.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

stract & list_uids=16098437 & query_hl=4

> 2. Using exercise to revert to NSR - are there any scientific papers

> or just anecdotal evidence?

I don't recall reading any but you'll find loads referring to how AERP

(Atrial effective refractory period) influences AF. Exercise is just one

of the ways to mess with this variable.

>

> 3. Dehydration and/or electrolyte depletion as triggers for AFib -

> again are there any scientific papers or just anecdotal evidence?

not sure about the dehydration but you'll find some mention of electrolytes

(also search PubMed/Google for 'exhausted horse syndrome')

> 4. Work and emotional stress as triggers for AFib - again are there

> any scientific papers or just anecdotal evidence?

again, PubMed is the place to go, you should find these and more...

The relationship between personality, socio-economic factors, acute life

stress and the development, spontaneous conversion and recurrences of

acute lone atrial fibrillation.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

stract & list_uids=15878557 & query_hl=14

Arrhythmia-provoking factors and symptoms at the onset of paroxysmal

atrial fibrillation: a study based on interviews with 100 patients

seeking hospital assistance.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Ab

stract & list_uids=15291967 & query_hl=14

> Thanks in advance to anyone who can help.

>

> Mark

>

If you want to find any free full text articles start your search

here...

http://www.ncbi.nlm.nih.gov:80/gquery/gquery.fcgi

then click on the numbers next to these two..

PubMed: biomedical literature citations and abstracts

PubMed Central: free, full text journal articles

Hope this helps

--

D

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

Thanks . That is typical of me, yelling before I have read it

all. (The long one BTW)

Sue

> > Thanks for that link Mark. I intend to comment too.

> > My first reaction is that there is no reference to ablation as a

> > treatment option (I find this very worrying).

> which document are you reading Sue? - it's in the long one (12.3.3

page

> 127 is where you'll find PVI)

>

http://www.nice.org.uk/pdf/atrialfibrillation1stconsultationfullguide

line.pdf

>

>

> and in the short one on page 23 1.9.3

>

http://www.nice.org.uk/pdf/Atrialfibrillation1stconsultationNICEguide

line.pdf

>

> --

> D

>

[Guest guest]

Thanks . That is typical of me, yelling before I have read it

all. (The long one BTW)

Sue

> > Thanks for that link Mark. I intend to comment too.

> > My first reaction is that there is no reference to ablation as a

> > treatment option (I find this very worrying).

> which document are you reading Sue? - it's in the long one (12.3.3

page

> 127 is where you'll find PVI)

>

http://www.nice.org.uk/pdf/atrialfibrillation1stconsultationfullguide

line.pdf

>

>

> and in the short one on page 23 1.9.3

>

http://www.nice.org.uk/pdf/Atrialfibrillation1stconsultationNICEguide

line.pdf

>

> --

> D

>

[Guest guest]

Thanks . That is typical of me, yelling before I have read it

all. (The long one BTW)

Sue

> > Thanks for that link Mark. I intend to comment too.

> > My first reaction is that there is no reference to ablation as a

> > treatment option (I find this very worrying).

> which document are you reading Sue? - it's in the long one (12.3.3

page

> 127 is where you'll find PVI)

>

http://www.nice.org.uk/pdf/atrialfibrillation1stconsultationfullguide

line.pdf

>

>

> and in the short one on page 23 1.9.3

>

http://www.nice.org.uk/pdf/Atrialfibrillation1stconsultationNICEguide

line.pdf

>

> --

> D

>

[Guest guest]

>

> Mark,

>

> I see no reference to ablations in the UK. I recently listened to

a BBC

> programme where the Medical advisor suggested that ablations were

not tried

> and tested procedure and caution should be given anyone going for

this types

> of treatments.

>

> Why is the uk lagging behind on this as the French and the USA

going for

> gold with ablations.

[snip]

. That is a very good question. Various procedures are being

done in scattered places but judging by my experience with docs

here, the level of ignorance about the condition and its treatment

is breath taking. My own GP when asked what an ablation procedure is

told me the incision is made at the base of the neck. (???)

We need to raise awareness amonst the profession somehow.

Harefield Hospital has mentioned the possibility but it always seems

to be thought of as a last resort. When " Mini Maze " is mentioned,

the response is blank looks.

Sue

[Guest guest]

>

> Why is the uk lagging behind on this as the French and the USA going for

> gold with ablations.

>

Hi without any hard numbers it's going to be hard to say if there

is a lag. (though my gut reaction is the same as yours)

For the US to be roughly on par with the UK they need about 5 times as

many EPs (UK population about 60 million US about 300 million). It

stands to reason that our guts are feeling a lag simply because there

are 5 times as many Americans with the problem and probably a similar

bias to American posters on this support group. (getting our guts to

feel fine if we hear 5 times as much noise from the US than the UK is a

trick I haven't learnt

Whilst it's clear that the number of ablations is rising it still

represents only a tiny minority of AFers (and the numbers are even

smaller for MAZE, mini Maze etc). 'going for gold' might be a

misrepresentation for a procedure performed on considerably less than 1%

of AFers (this number is a guess by me but I'm reasonably confident it's

going to be a small number of the AF population who go for ablations).

The ablation procedure is still on it's learning curve and is still a

good few years away from being a procedure that can be performed by an

'average' EP.

I'm all for raising awareness in the UK but I don't expect every NHS

hospital to be offering PVIs anytime soon.

P.S. to Sue - my PVI ablation involved 3 catheters, two in the leg and

one in the neck. My GPs know very little about the PVI too but I'm not

sure I'd expect them to - as long as they refer me to the specialists

aren't they doing their job? (and my specialist in Leeds knows when to

hand me to a PVI specialist) Whilst I'm all for raising awareness

medicine is way too complicated for GPs to know all the answers.

--

D

[Guest guest]

Sue,

You comments are going to the convinced, you have to write and shout at mark

he is the man who has written these. I am an internet engineer.

C Uk

>

> Mark,

>

> I see no reference to ablations in the UK. I recently listened to

a BBC

> programme where the Medical advisor suggested that ablations were

not tried

> and tested procedure and caution should be given anyone going for

this types

> of treatments.

>

> Why is the uk lagging behind on this as the French and the USA

going for

> gold with ablations.

[snip]

. That is a very good question. Various procedures are being

done in scattered places but judging by my experience with docs

here, the level of ignorance about the condition and its treatment

is breath taking. My own GP when asked what an ablation procedure is

told me the incision is made at the base of the neck. (???)

We need to raise awareness amonst the profession somehow.

Harefield Hospital has mentioned the possibility but it always seems

to be thought of as a last resort. When " Mini Maze " is mentioned,

the response is blank looks.

Sue

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.

[Guest guest]

Sue,

You comments are going to the convinced, you have to write and shout at mark

he is the man who has written these. I am an internet engineer.

C Uk

>

> Mark,

>

> I see no reference to ablations in the UK. I recently listened to

a BBC

> programme where the Medical advisor suggested that ablations were

not tried

> and tested procedure and caution should be given anyone going for

this types

> of treatments.

>

> Why is the uk lagging behind on this as the French and the USA

going for

> gold with ablations.

[snip]

. That is a very good question. Various procedures are being

done in scattered places but judging by my experience with docs

here, the level of ignorance about the condition and its treatment

is breath taking. My own GP when asked what an ablation procedure is

told me the incision is made at the base of the neck. (???)

We need to raise awareness amonst the profession somehow.

Harefield Hospital has mentioned the possibility but it always seems

to be thought of as a last resort. When " Mini Maze " is mentioned,

the response is blank looks.

Sue

Web Page - http://www.afibsupport.com

List owner: AFIBsupport-owner

For help on how to use the group, including how to drive it via email,

send a blank email to AFIBsupport-help

Nothing in this message should be considered as medical advice, or should be

acted upon without consultation with one's physician.