HJNO Sep/Oct 2022

HEALTHCARE JOURNAL OF NEW ORLEANS I  SEP / OCT 2022 33 For weekly eNews updates and to read the journal online, visit HealthcareJournalNO.com can optimize treatment paths and tailor the appropriate therapy regimens according to patients’ unique needs. Global AFib Study Finds Simple Procedures Work Best Results from one of the largest global studies of atrial fibrillation (AFib) procedures show that the simple approach is usually best when it comes to ablation, a procedure where physicians destroy or ablate cardiac tissue to correct irregular heart rhythms. The findings could change the way patients are treated for AFib. Researchers from Tulane University and partner institutions found that using advanced image- guided technology to more aggressively target diseased areas of the heart that cause arrythmias didn’t lead to better outcomes for patients — and put some at higher risk of strokes, according to results of the DECAAF II trial published in JAMA. “Simplicity is key. Don’t ablate too much, especially at advanced stages,” said lead study author Nassir Marrouche, MD, director of the Tulane Heart and Vascular Institute and The Research Innovation for Arrhythmia Discoveries (TRIAD) at Tulane University School of Medicine. “Too much ablation is not helping our patients today. It is putting them at higher risk. This is a practice-changing finding from our study.” AFib occurs when the upper and lower chambers of the heart are out of sync, causing the heart to beat irregularly. It affects more than 2.7 million Americans and is a leading risk factor for strokes. When AFib cannot be controlled by medication, doctors perform a procedure to ablate fibrotic or diseased areas of the heart with heat or cold to create a scar that disrupts the electrical signal that causes the arrhythmia. For the study, researchers followed 843 AFib patients undergoing ablation treatment at 44 hospitals in 10 countries. Half of the patients received standard care — pulmonary vein isolation (PVI) treatment where doctors ablate areas in the left upper chamber of the heart where the four lung veins meet. For the other group, doctors used MRI scans to create a detailed 3D map of all diseased areas along the left atrium of the heart. They performed conventional PVI treatment and then used the digital map to ablate diseased tissue more aggressively and precisely outside of conventional treatment areas. Researchers found no significant difference in arrhythmia recurrence between the two groups. However, the group that received the more aggressive treatment experienced a higher rate of poor safety outcomes with six patients (1.5%) suffering a stroke. Marrouche said that the study shows that AFib patients with extensive fibrosis have too much scarring for aggressive ablative therapy to be effective using conventional tools. Researchers also suspect that it is not only the extent of fibrosis that played a role in the study outcomes. In evaluating hundreds of procedures by the world’s leading electrophysiologists, they discovered that there is little uniformity in how doctors perform ablation interventions, which may also contribute to disparate outcomes, Marrouche said. “Atrial fibrillation procedures have become too complex over the years. We are ablating hundreds of thousands of people a year now, and we have been striving to do more and more ablation for the population with persistent or continuous AFib,” Marrouche said. “But our study shows that isn’t necessary, especially for those with more myopathy. Simple ablations can effectively treat these patients instead of going for extensive ablation to treat fibrotic areas that we struggle to control.” LDH Surveillance Finding High Numbers of Mosquitoes Infected withWest Nile Virus The Louisiana Department of Health (LDH) has received reports of West Nile virus present in more than 175 mosquito pools this year, a number much higher than last year at this time, when 13 pools tested positive. The high number of positive cases in the pool samples means there is a greater risk of West Nile virus spreading to humans. The Office of Public health is urging the public to take protective measures against mosquito bites. West Nile virus is spread by mosquitoes and can cause illness in people and animals. While 80% of human cases are asymptomatic, many people can develop West Nile Fever. Symptoms of West Nile Fever, which is a flu-like illness, can include fever, headache, body aches, nausea or rashes. A small percentage of people sickened by West Nile Virus can develop a severe form of infection called West Nile Neuroinvasive Disease or West Nile Encephalitis, which can result in hospitalization and death. Symptoms can include high fever, stiff neck, disorientation, muscle weakness, numbness, coma and paralysis. These symptoms may last several weeks and carry the risk of death or permanent brain damage. While anyone is at risk of developing severe disease, individuals with pre-existing medical conditions and those who are over 60 years of age are at a greater risk. The number of West Nile Neuroinvasive Disease cases fluctuates each year due to many environmental factors and the weather, with previous case counts in Louisiana ranging between 4 and 204 cases each year. “Now is the time to start protecting yourself from mosquito bites and eliminating mosquito breeding sites around your home,” said LDH State Health Officer Dr. Joseph Kanter. “We’re getting early warning signs from our Mosquito Abatement District samples across the state that West Nile Virus could result in higher case counts among humans this summer.” LSUHealth NO School of Nursing Expands Courses to North Louisiana Starting in January 2023, LSU Health New Orleans’ School of Nursing will educate students in three accelerated nursing programs in North Louisiana at its newly approved Off-Campus Instructional Site located on the LSU Health Shreveport campus. Courses will be delivered through a combination of in-person instruction and synchronous distance education, where students in Shreveport will virtually join classes going on at the LSU Health New Orleans School of Nursing. LSU Shreveport and LSU Health Shreveport faculty will also teach some basic science courses. Applications are now open for the Career Alternative RN Education (CARE) Program, a two- year program designed for individuals who have earned a bachelor’s degree from an accredited college or university in any field and would like to become a nurse. Students will graduate from LSU Health New Orleans with a Bachelor of Nursing Science degree.