Changes in the structure and electrical behaviour of the left atrium are known to occur with conditions that predispose to atrial fibrillation (AF) and in response to prolonged periods of AF. We review the evidence that changes in myocardial thickness in the left atrium are an important part of this pathological remodelling process. Autopsy studies have demonstrated changes in the thickness of the atrial wall between patients with different clinical histories. Comparison of the reported tissue dimensions from pathological studies provides an indication of normal ranges for atrial wall thickness. Imaging studies, most commonly done using cardiac computed tomography, have demonstrated that these changes may be identified non-invasively. Experimental evidence using isolated tissue preparations, animal models of AF, and computer simulations proves that the three-dimensional tissue structure will be an important determinant of the electrical behaviour of atrial tissue. Accurately identifying the thickness of the atrial may have an important role in the non-invasive assessment of atrial structure. In combination with atrial tissue characterization, a comprehensive assessment of the atrial dimensions may allow prediction of atrial electrophysiological behaviour and in the future, guide radiofrequency delivery in regions based on their tissue thickness.

Objective Tonsillectomy is a common surgical procedure in the UK. This study critically examined the current advice provided by UK hospitals to patients about post-operative care. Method Post-tonsillectomy patient advice sheets were obtained from 110 UK National Health Service trusts and equivalent organisations. Their contents were analysed and compared with published literature to determine whether the advice being given to patients was evidence-based. Results Post-tonsillectomy dietary and fluid intake advice varied between hospitals; although many recommended eating and drinking a normal diet (88 per cent), some recommended eating ‘hard’ (26 per cent) or ‘soft’ (8 per cent) foods. Non-evidence based advice given included avoiding fizzy drinks (21 per cent), fruit juices (9 per cent) and using chewing gum (51 per cent). Reported post-operative risks and safety-netting also varied. Conclusion Much of the advice in the available printed information appeared to be anecdotal and not based on, or was contrary to, published evidence. After review of the literature, an evidence-based post-tonsillectomy patient advice sheet was generated for dissemination.

Background Tonsillectomy is one of the commonest surgical procedures performed in the UK, with just over 45,000 recorded in England in 2018-2019(1). Despite this there is wide variation in, and a lack of evidence for, the post-operative advice given to patients. Method Post-tonsillectomy patient advice sheets were obtained from 110 UK NHS Trusts and equivalent organisations. Their contents were analysed and compared with published literature on post-tonsillectomy management to determine whether the advice is evidence-based or not. Results Post-tonsillectomy dietary and fluid intake advice varied between hospitals; whilst many recommend eating and drinking a normal diet (88%), many recommended eating a ‘hard’ (26%) or ‘soft’ (8%) food diet. Literature written for adults was more likely to encourage adequate fluid intake than that for children (75% versus 25%). Non-evidence-based advice including avoiding fizzy drinks (21%), fruit juices (9%), and using chewing gum (51%), was frequently given. Reported post-operative risks and safety-netting also varied, with 71% advising urgent hospital attendance if any bleeding was experienced whilst 12% suggested that bleeding up to a spoonful was to be expected and should not necessarily be acted upon. Conclusions Much of the advice given appeared to be anecdotal and not based on, or contrary to, published evidence.