Breaking News
December 13, 2018 - NIH offers support for HIV care and prevention research in the southern United States
December 12, 2018 - Activating brain region could revive the urge to socialize among opioid addicts
December 12, 2018 - Relationship impairment appears to interfere with seeking mental health treatment in men
December 12, 2018 - Sleep, Don’t Cram, Before Finals for Better Grades
December 12, 2018 - Effective treatments for urticarial vasculitis
December 12, 2018 - Gun violence is a public health issue: One physician’s story
December 12, 2018 - The Science of Healthy Aging
December 12, 2018 - Yes to yoghurt and cheese: New improved Mediterranean diet
December 12, 2018 - Researchers uncover a number of previously unknown insecticide resistance mechanisms
December 12, 2018 - Regulating the immune system’s ‘regulator’
December 12, 2018 - In breaking bad news, the comfort of silence
December 12, 2018 - Study finds upward link between alcohol consumption and physical activity in college students
December 12, 2018 - FDA issues warning letter to Zhejiang Huahai Pharmaceutical involved in valsartan recall
December 12, 2018 - Presence of antiphospholipid antibodies tied to first-time MI
December 12, 2018 - New study could help inform research on preventing falls
December 12, 2018 - Women and men with heart attack symptoms receive different care from EMS
December 12, 2018 - Disrupted biological clock can contribute to onset of diseases, USC study shows
December 12, 2018 - New publications generate controversy over the value of reducing salt consumption in populations
December 12, 2018 - New data from TAILORx trial confirms lack of chemo benefit regardless of race or ethnicity
December 12, 2018 - Specific class of biomarkers can accurately indicate the severity of cancer
December 12, 2018 - Meds Taken Do Not Vary With ADL Impairment in Heart Failure
December 12, 2018 - Long-term study shows that HIV-2 is deadlier than previously thought
December 12, 2018 - People living near oil and gas wells show early signs of cardiovascular disease
December 12, 2018 - IONTAS founder and pioneer in phage display technology attends Nobel Prize Award Ceremony
December 12, 2018 - People who eat red meat have high levels of chemical associated with heart disease, study finds
December 12, 2018 - New method uses water molecules to unlock neurons’ secrets
December 12, 2018 - Genetics study offers hope for new acne treatment
December 12, 2018 - New computer model predicts prostate cancer progression
December 12, 2018 - Nobel Laureates lecture about immune checkpoint therapy for cancer treatment
December 12, 2018 - More Illnesses From Tainted Romaine Lettuce Reported
December 12, 2018 - Aspirin could reduce HIV infections in women
December 12, 2018 - The EORTC Brain Tumor Group and Protagen AG collaborate to study immuno-competence of long-term glioblastoma survivors
December 12, 2018 - Insights into magnetotactic bacteria could guide development of biological nanorobots
December 12, 2018 - Sacrificial immune cells alert body to infection
December 12, 2018 - Low-salt diet may be more beneficial for females than males
December 12, 2018 - Major soil organic matter compound battles chronic wasting disease
December 12, 2018 - Findings may open up new ways to treat dwarfism and other ER-stress-related conditions
December 12, 2018 - New computational model provides clearer picture of shape-changing cells’ structure and mechanics
December 12, 2018 - 10 Facts on Patient Safety
December 12, 2018 - Poorest dying nearly 10 years younger than the rich in ‘deeply worrying’ trend for UK
December 12, 2018 - Innovative care model for children with ASD reduces use of behavioral drugs in ED
December 12, 2018 - Spending time in and around Hong Kong’s waters linked to better health and wellbeing
December 12, 2018 - Simple measures to prevent weight gain over Christmas
December 12, 2018 - Research advances offer hope for patient-tailored AML treatment
December 12, 2018 - Researchers discover a ‘blind spot’ in atomic force microscopy
December 12, 2018 - Sprayable gel could help prevent recurrences of cancer after surgery
December 12, 2018 - SLU researchers explore how fetal exposure to inflammation can alter immunity in newborns
December 12, 2018 - How do patients want to discuss symptoms with clinicians?
December 12, 2018 - Zinc chelation may be able to deliver drug to insulin-producing cells
December 12, 2018 - Brigham researchers develop automated, low-cost tool to predict a woman’s ovulation
December 12, 2018 - Some people with Type 2 diabetes may be testing their blood sugar more often than needed
December 12, 2018 - Slow-growing type of glioma may be vulnerable to immunotherapy, suggests study
December 12, 2018 - Study provides new information regarding microRNA function in cellular homeostasis of zebrafish
December 12, 2018 - Study provides new understanding of mysterious ‘hereditary swelling’
December 12, 2018 - Researchers shed new light on how to combat Shiga and ricin toxins
December 12, 2018 - Pregnant Women Commonly Refuse Vaccines
December 12, 2018 - Drug treatment could offer new hope for some patients with brain bleeding
December 12, 2018 - Health care financial burden of animal-related injuries is growing, study says
December 12, 2018 - Macrophage cells could help repair the heart following a heart attack, study finds
December 12, 2018 - Researchers develop new system for efficiently producing human norovirus
December 12, 2018 - New artificial intelligence-based system to differentiate between different types of cancer cells
December 11, 2018 - Brazilian professors propose guidelines for therapeutic use of melatonin
December 11, 2018 - Healthy Lifestyle Lowers Odds of Breast Cancer’s Return
December 11, 2018 - New research identifies two genes linked to serious congenital heart condition
December 11, 2018 - NIH Director talks science, STEM careers with preteens
December 11, 2018 - Disabling a Cellular Antivirus System Could Improve Gene Therapy
December 11, 2018 - New tool swiftly provides accurate measure of patients’ cognitive difficulties
December 11, 2018 - NICE releases new guidelines for diagnosis and management of COPD
December 11, 2018 - Without Obamacare penalty, think it’ll be nice to drop your plan? Better think twice
December 11, 2018 - Researchers capture high-resolution X-ray and NMR image of key immune regulator
December 11, 2018 - Natural flavonoid is effective at treating leishmanisis infections, study shows
December 11, 2018 - Avoidant grievers unconsciously monitor and block mind-wandering contents, study shows
December 11, 2018 - Study identifies how hantaviruses infect lung cells
December 11, 2018 - Improving PTSD care through genetics
December 11, 2018 - Dermatology providers show interest in recommending cannabinoids to patients
December 11, 2018 - Researchers to study effects of electroconvulsive therapy on Alzheimer’s patients with aggression
December 11, 2018 - Four dried fruits have lower glycemic index than starchy foods, study finds
December 11, 2018 - Optimization of drug dose sizes can reduce pharmaceutical wastage
December 11, 2018 - Ultrarestrictive opioid prescribing strategy linked with reduction in number of pills dispensed
December 11, 2018 - PET scans to optimize tuberculosis meningitis treatments and personalize care, study finds
Botulinum toxin injections show promise to suppress postoperative atrial fibrillation

Botulinum toxin injections show promise to suppress postoperative atrial fibrillation

image_pdfDownload PDFimage_print

Postoperative atrial fibrillation (POAF) is a common complication, affecting one quarter to one half of all patients following cardiac surgery. It can result in heart failure, stroke, and longer hospital stays, resulting in an increased cost of care. HeartRhythm, the official journal of the Heart Rhythm Society and the Cardiac Electrophysiology Society, reports promising results from two clinical trials using botulinum toxin (BTX) injections to suppress POAF.

BTX, a potent inhibitor of neural transmission, is best known for its use in temporarily reducing facial wrinkles. The global cosmetic market for BTX was estimated at US $3.4 billion in 2015. It is also used to treat some neurological disorders including excessive sweating and eye muscle disorders.

In a randomized placebo-controlled longitudinal study of 60 patients undergoing coronary artery bypass graft surgery, patients who received BTX injections during surgery showed a sustained reduction in the incidence and overall burden of atrial fibrillation (AF) over three years of follow-up, accompanied by a reduced need for hospitalization. BTX was injected into each of the epicardial fat pads near each pulmonary vein.

Senior investigator Jonathan S. Steinberg, MD, of the Heart Research Follow-up Program, University of Rochester School of Medicine & Dentistry, Rochester, NY, USA, explains, “This study tested the hypothesis that interruption of cardiac neural traffic by BTX could undermine the pathologic processes that promote AF after cardiac surgery. In two previous publications, the study group has shown significant reductions in early postoperative AF up to 30 days, but also sustained reduction of AF out to one year.”

In the current study, AF events were captured by implantable cardiac monitors in all patients. The incidence of AF was reduced by 64 percent in patients who received BTX. Further, the overall burden of AF was reduced five- to nine-fold in each year of follow-up. Over three years, the number of patients who required hospitalization for AF, the total number of hospitalizations, and the need for drug therapies or additional procedures were all reduced in the BTX group.

“The results of our studies suggest a new approach to treatment of AF,” says Dr. Steinberg. “The sustained reduction of AF, now demonstrated over three years, was notable and a bit of a surprise. We believe that autonomic remodeling was interrupted and the predisposition to AF was reset as a result of BTX injection.” The BTX concept could also be tested in non-postoperative patients in future studies, extending the treatment paradigm of neuromodulation as a stand-alone or supplemental antiarrhythmic strategy, which may potentially be applicable to the many other clinical contexts in which AF appears.

According to Dr. Steinberg, this is potentially an important and impactful breakthrough if confirmed in larger trials. If postoperative AF is reduced, there may be significant reduction in the utilization of health care resources, an important goal for healthcare systems under stress because of high costs. There may also be long-term clinical and financial benefits.

In the second trial reported in this issue, Nathan H. Waldron, MD, MHS, of the Department of Anesthesiology, and colleagues at Duke University, Durham, NC, USA, randomized 130 patients to receive an injection of either 250 units of botulinum toxin type A (BoNTA) or saline in epicardial fat pads containing autonomic ganglia after the start of cardiopulmonary bypass, but before the surgical procedure. They assessed the occurrence of POAF with continuous telemetry during postoperative hospitalization. There was no increase in complications after cardiac surgery, but the procedure did not result in a statistically significant reduction in the risk of POAF. The investigators consider this may be due to inadequate power to detect a modest, but clinically meaningful, impact of BoNTA.

“While we did not observe a statistically significant reduction in the occurrence of POAF, patients receiving epicardial botulinum toxin had shorter initial episodes of POAF and a trend toward less hemodynamically significant POAF,” notes Dr. Waldron.

“The patients treated with toxin had an 11 percent lower risk of post-operative AF that did not meet statistical significance, so a larger, adequately powered trial is something that is needed to provide a clearer picture,” adds senior author Jonathan P. Piccini, MD, a member of the Duke Clinical Research Institute (DCRI), Durham, North Carolina, USA.

In an accompanying editorial, Joris R. de Groot, MD, PhD, of the Department of Cardiology, Heart Center, Amsterdam University Medical Centers, University of Amsterdam, The Netherlands, examines the different outcomes of the two studies and points out some key differences. For example, the first study included only coronary artery bypass grafting (CABG) patients, whereas the second study also included patients undergoing valve or combined surgery. The atrial sizes were also different between these studies.

“Studies with botulinum toxin type A injection into the ganglion plexi remain confined to patients undergoing open-chest surgery, and a larger scale clinical trial with botulinum injection into the ganglion plexi in CABG patients is on the way,” Dr. de Groot comments. “For AF treatment or suppression in patients not undergoing thoracotomy, nonthermal ablation appears a promising approach that proved tissue-specific, and merits further clinical investigation.”

Source:

https://www.elsevier.com/

Tagged with:

About author

Related Articles