The KB algorithm for AF detection supported by physician review can accurately differentiate AF from SR. This technology can help screen patients prior to elective CV and avoid unnecessary procedures.

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Background-Atrial fibrillation (AF) ablation is increasingly used in clinical practice. We aimed to study the natural history and long-term outcomes of ablated AF. Methods and Results-We followed 831 patients after pulmonary vein isolation (PVI) performed in 2005. We documented clinical outcomes using our prospective AF registry with most recent update on this group of patients in October 2009. In the first year after ablation, 23.8% had early recurrence. Over long-term follow-up (55 months), only 8.9% had late arrhythmia recurrence defined as occurring beyond the first year after ablation. Repeat ablations in patients with late recurrence revealed conduction recovery in at least 1 of the previously isolated PVs in all of them and right-sided triggers with isoproterenol testing in 55.6%. At last follow-up, clinical improvement was 89.9% (79.4% arrhythmia-free off antiarrhythmic drugs and 10.5% with AF controlled with antiarrhythmic drugs). Only 4.6% continued to have drug-resistant AF. It was possible to safely discontinue anticoagulation in a substantial proportion of patients with no recurrence in the year after ablation (CHADS score Յ2, stroke incidence of 0.06% per year). The procedure-related complication rate was very low. Conclusions-Pulmonary vein isolation is safe and efficacious for long-term maintenance of sinus rhythm and control of symptoms in patients with drug-resistant AF. It obviates the need for antiarrhythmic drugs, negative dromotropic agents, and anticoagulants in a substantial proportion of patients. (Circ Arrhythm Electrophysiol. 2011;4:271-278.)

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Although heparin has been used clinically for prophylaxis and treatment of thrombosis, it has suffered from problems such as short duration within compartments in vivo that require long term anticoagulation. A covalent antithrombin-heparin complex has been produced with high anticoagulant activity and a long half-life relative to heparin. The product had high anti-factor Xa and antithrombin activities compared with noncovalent mixtures of antithrombin and heparin (861 and 753 units/mg versus 209 and 198 units/mg, respectively). Reaction with thrombin was rapid with bimolecular and second order rate constants of 1.3 ؋ 10 9 M ؊1 s ؊1 and 3.1 ؋ 10 9 M ؊1 s ؊1 , respectively. The intravenous half-life of the complex in rabbits was 2.6 h as compared with 0.32 h for similar loads of heparin. Subcutaneous injection of antithrombin-heparin resulted in plasma levels (peaking at 24 -30 h) that were still detectable 96 h post-injection. Given the increased lifetime in these vascular and intravascular spaces, use of the covalent complex in the lung was investigated. Activity of antithrombin-heparin instilled into rabbit lungs remained for 48 h with no detection of any complex systemically. Thus, this highly active agent has features required for pulmonary sequestration as a possible treatment for thrombotic diseases such as respiratory distress syndrome.