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Biomedical subjects

Daniel Cher

Publications and source records attributed to Daniel Cher.

5 recordsLinked to original sources
PubMed2005

Hybrid therapy with right atrial catheter ablation and previously ineffective antiarrhythmic drugs for the management of atrial fibrillation.

BACKGROUND: Many patients with paroxysmal atrial fibrillation (AF) become refractory to antiarrhythmic drugs (AADs). Early studies suggested that linear catheter ablation in the right atrium may provide sufficient substrate modification to reestablish therapeutic efficacy of previously ineffective AADs. METHODS: This prospective before-after multicenter trial evaluated the safety and effectiveness of hybrid therapy that included right atrial catheter ablation coupled with a regimen of previously ineffective AADs on AF episode frequency and symptoms in drug refractory patients with paroxysmal AF. A standard linear lesion set (lateral, septal, isthmus) was used in all subjects. AF episode frequency, clinical arrhythmia symptoms, condition-specific (AFSS) and global health-related quality of life (SF-36) were assessed prior to ablation and at 6 months. RESULTS: Ninety-three subjects, refractory to an average 2.9 AADs at baseline, qualified for inclusion and underwent right atrial catheter ablation. Eighty-four subjects (90%) provided 6 month AF episode frequency data which demonstrated a significant decrease compared to baseline (3.4 vs. 9.5, p < 0.0001). Forty-nine subjects (58%) were considered a clinical success by virtue of achieving a pre-specified target level episode frequency reduction of 50% or greater. Substantial and statistically significant improvements were realized almost uniformly for all measured arrhythmia symptoms as well as for both quality of life measures. The incidence of major complications was 5.4%. CONCLUSIONS: The addition of right atrial catheter ablation to a regimen of previously ineffective AADs is associated with a significant reduction in the frequency, duration and severity of AF episodes and symptoms.

Amiodarone↗
PubMed2005

Occupational magnetic field exposure, cardiovascular disease mortality, and potential confounding by smoking.

PURPOSE: To assess the relationship between occupational magnetic field (MF) exposure and cardiovascular disease (CVD) mortality and to determine whether smoking could confound this relationship. METHODS: Death certificate and proxy respondent information from the US 1986 and 1993 National Mortality Followback Surveys (NMFS) were used to determine whether job titles with potential occupational MF exposure were risk factors for CVD mortality and whether smoking behavior may confound the observed relationship. A qualitative MF exposure matrix was developed based on job titles and published exposure measurements. In a case-control analysis, logistic regression models, adjusting for age, sex, race, working status, level of education, and survey year, were used to examine the associations between estimated MF exposure and death from CVD. To assess the effect of adjustment for smoking, we conducted our analyses with and without including smoking-related variables in the models, and evaluated the change in CVD risk estimates. RESULTS: There was no consistent dose-response relationship between occupational MF exposure estimates and CVD mortality. Adjustment for smoking behavior did not appreciably change the observed MF exposure-CVD mortality relationship. CONCLUSIONS: Although limited by self-reported information on exposure and smoking, our results suggest that CVD mortality was not associated with MF exposure in this study, and smoking behavior was not an apparent confounder of the MF-CVD association.

Cardiovascular Diseases↗
PubMed2003

Microinsert nonincisional hysteroscopic sterilization.

OBJECTIVE: To assess the safety, effectiveness, and reliability of a tubal occlusion microinsert for permanent contraception, as well as to document patient recovery from the placement procedure and overall patient satisfaction. METHODS: A cohort of 518 previously fertile women seeking sterilization participated in this prospective, phase III, international, multicenter trial. Microinsert placement was attempted in 507 women. Microinserts were placed bilaterally into the proximal fallopian tube lumens under hysteroscopic visualization in outpatient procedures. RESULTS: Bilateral placement of the microinsert was achieved in 464 (92%) of 507 women. The most common reasons for failure to achieve satisfactory placement were tubal obstruction and stenosis or difficult access to the proximal tubal lumen. More than half of the women rated the average pain during the procedure as either mild or none, and 88% rated tolerance of device placement procedure as good to excellent. Average time to discharge was 80 minutes. Sixty percent of women returned to normal function within 1 day or less, and 92% missed 1 day or less of work. Three months after placement, correct microinsert placement and tubal occlusion were confirmed in 96% and 92% of cases, respectively. Comfort was rated as good to excellent by 99% of women at all follow-up visits. Ultimately, 449 of 518 women (87%) could rely on the microinsert for permanent contraception. After 9620 woman-months of exposure to intercourse, no pregnancies have been recorded. CONCLUSION: This study demonstrates that hysteroscopic interval tubal sterilization with microinserts is well tolerated and results in rapid recovery, high patient satisfaction, and effective permanent contraception.

Adult↗
PubMed2003

Hysteroscopic sterilization using a micro-insert device: results of a multicentre Phase II study.

BACKGROUND: Unlike laparoscopic surgery for interval tubal sterilization, a hysteroscopic approach obviates surgical incision and requires only local anaesthesia or intravenous sedation. The safety, tolerability and efficacy of an hysteroscopically placed micro-insert device was evaluated. METHODS: A cohort of 227 previously fertile women participated in this prospective international multicentre trial. Micro-inserts were placed bilaterally into the proximal Fallopian tube lumens under hysteroscopic visualization in outpatient procedures. RESULTS: Successful bilateral micro-insert placement was achieved in 88% of women. The majority of women reported that intraprocedural pain was less than or equal to that expected, and 90% rated tolerance of the device placement procedure as good to excellent. Most women could be discharged in an ambulatory state within 1-2 h. Adverse events occurred in 7% of the women, but none was serious. Correct device placement was confirmed in 97% of cases at 3 months. Over 24 months follow-up, 98% of study participants rated their tolerance of the micro-insert as very good to excellent. After 6015 woman-months of exposure to intercourse, no pregnancies have been recorded. CONCLUSIONS: Hysteroscopic sterilization resulted in rapid patient recovery without unacceptable post-procedure pain, as well as high long-term patient tolerability, satisfaction and effective permanent contraception.

Adult↗