Abstracts Archive 2003

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Implantable Cardioverter-Defibrillator Therapy for Prevention of Sudden Death in Patients with Arrhythmogenic Right Ventricular Cardiomyopathy/Dysplasia

In patients with ARVC/D, ICD therapy provided life-saving protection by effectively terminating life-threatening ventricular arrhythmias. Patients who were prone to ventricular fibrillation/flutter could be identified on the basis of clinical presentation, irrespective of programmed ventricular stimulation outcome.

Determinants of Sudden Cardiac Death in Individuals with the Electrocardiographic Pattern of Brugada Syndrome and No Previous Cardiac Arrest

Multivariate analysis identified the inducibility of a sustained ventricular arrhythmia (P<0.0001) and a history of syncope (P<0.01) as predictors of events. Logistic regression analysis showed that a patient with a spontaneously abnormal ECG, a previous history of syncope, and inducible sustained ventricular arrhythmias had a probability of 27.2% of suffering an event during follow-up.

Use of automated external defibrillator by first responders in out of hospital cardiac arrest: prospective controlled trial

Use of automated external defibrillators by first responders did not significantly increase survival to discharge from hospital, although it did improve return of spontaneous circulation and admission to hospital. Improved dispatch procedures should increase the success of programmes of first responders using external defibrillators.

Congenital Short QT Syndrome and Implantable Cardioverter Defibrillator Treatment: Inherent Risk for Inappropriate Shock Delivery

The congenital short QT syndrome constitutes a new clinical entity with an increased risk for sudden cardiac death. Currently, ICD treatment is the only therapeutic option.

Implantable Cardioverter Defibrillator Events in Patients with Asymptomatic Nonsustained Ventricular Tachycardia: Is Device Implantation Justified?

Patients with coronary disease and asymptomatic NSVT commonly receive appropriate defibrillator therapy. These results support the need for ICD implantation for primary prevention, with attention to careful programming of the detection rate to prevent inappropriate therapy.

Usefulness of ST-segment elevation in lead aVR during tachycardia for determining the mechanism of narrow QRS complex tachycardia

aVR ST-segment elevation during narrow QRS complex tachycardia favors the atrioventricular reentry through an accessory pathway as the mechanism of the tachycardia.

Total Atrioventricular Nodal Ablation Increases Atrial Fibrillation Burden in Patients with Paroxysmal Atrial Fibrillation Despite Continuation of Antiarrhythmic Drug Therapy

TAVN ablation increases AF burden and facilitates the development of persistent AF in patients with paroxysmal AF despite the continuation of antiarrhythmic drugs. Loss of AV and/or interventricular synchrony may lead to altered cardiac hemodynamics resulting in atrial stretch and increasing AF burden.

Left Atrial Radiofrequency Ablation During Cardiac Surgery in Patients with Atrial Fibrillation

Endocardial RF left atrial compartmentalization during cardiac surgery is effective in restoring sinus rhythm in many patients. This technique is easy to perform and reproducible. Rare RF ablation-related complications can occur. During follow-up, sinus rhythm persistence is good, and biatrial contraction is preserved in most patients.

Evaluation of the Appropriateness of Pacemaker Mode Selection in Bradycardia Pacing: How Closely are the ACC/AHA Guidelines Followed?

(1) elderly denied a dual chamber system with no clinical explanation and (2) selection of rate-modulated devices without any indication of chronotropic incompetence.

Optimal Pacing for Symptomatic AV Block: A Comparison of VDD and DDD Pacing

The lower cost, high reliability, and abbreviated implantation time suggest that VDD pacing is a viable alternative to DDD pacing in patients with high-degree AV block and normal sinus node function.  

Long-term effectiveness of cardiac resynchronization therapy in patients with refractory heart failure and “narrow” QRS

Cardiac resynchronization therapy determined clinical and functional benefit that was similar in patients with wide or “narrow” QRS. Cardiac resynchronization therapy may be helpful in patients with echocardiographic evidence of interventricular and intraventricular asynchrony and incomplete left bundle branch block.

Noninvasive Arrhythmia Risk Stratification in Idiopathic Dilated Cardiomyopathy: Results of the Marburg Cardiomyopathy Study

Reduced LV ejection fraction and lack of ß-blocker use are important arrhythmia risk predictors in IDC, whereas signal-averaged ECG, baroreflex sensitivity, heart rate variability, and T-wave alternans do not seem to be helpful for arrhythmia risk stratification.

The optimal intensity of vitamin k antagonists in patients with mechanical heart valves: A meta-analysis

This meta-analysis shows that both aortic and mitral valves will benefit from a treatment strategy with a target INR higher than 3.0.

Clinical efficacy of cardiac resynchronization therapy using left ventricular pacing in heart failure patients stratified by severity of ventricular conduction delay

Left ventricular pacing significantly improves exercise tolerance and quality of life in patients with chronic HF, LV systolic dysfunction, and a QRS interval over 150 ms.

Routine vitamin supplementation to prevent cardiovascular disease: a summary of the evidence for the U.S. preventive services task force

The US Preventive Services Task Force (USPSTF) concluded the evidence is insufficient to recommend for or against use of supplements of vitamin A, C or E; multivitamins with folic acid or antioxidant combinations for the prevention of cancer or CV disease. The USPSTF recommends against use of beta carotene supplements alone or in combination for the prevention of either cancer or CVD.

Inflammation as a Risk Factor for Atrial Fibrillation

CRP is not only associated with the presence of AF but may also predict patients at increased risk for future development of AF.

Successful Catheter Ablation of Electrical Storm after Myocardial Infarction

Incessant ventricular tachyarrhythmias after MI may be triggered by VPBs. RF ablation of the triggering VPBs is feasible and can prevent drug-resistant electrical storm, even after acute MI.

Long QT syndrome patients may faint due to neurocardiogenic syncope

Syncope in LQTS can be of neurocardiogenic origin and is not necessarily due to TdP.

Use of enalapril to facilitate sinus rhythm maintenance after external cardioversion of long-standing persistent atrial fibrillation

The addition of enalapril to amiodarone decreased the rate of immediate and subacute arrhythmia recurrences and facilitated subsequent long-term maintenance of sinus rhythm after cardioversion of persistent AF.

Diazepam or midazolam for external DC cardioversion (The DORM Study)

Physician-led cardioversion of atrial arrhythmias using intravenous sedation is effective and well tolerated. Sedation with diazepam was associated with fewer minor adverse events and a quicker recovery time than midazolam.

Chronic periodontitis, a significant relationship with acute myocardial infarction

Patients who at routine dental visits demonstrate evidence of bone loss around several teeth can predictably be identified as being at risk for future AMI.

Walk test at increased levels of heart rate in patients with dual-chamber pacemaker and with normal or depressed left ventricular function

Increasing heart rate in presence of ventricular asynchrony induced by dual-chamber pacing has negative effect on cardiac contractility and does not improve CO at rest or during physical activity in patients with depressed LV function as occurs in those with normal function.

Comparison of effectiveness of implantable cardioverter defibrillator in patients with idiopathic dilated cardiomyopathy versus those with proved coronary heart disease

There were no differences in the type and probability of recurrences at follow-up.

Optimal duration of monitoring in patients with unexplained syncope

There is a low risk of syncope after 1 year of monitoring without an event.

Water Ingestion as Prophylaxis Against Syncope

Water enhances tolerance of upright posture. The effect of water is mediated by increased peripheral vascular resistance.

Prevention of atrial fibrillation recurrence by statin therapy in patients with lone atrial fibrillation after successful cardioversion

The use of statins was associated with a significant decrease in the risk of arrhythmia recurrence after successful cardioversion of AF.
 

A new oral therapy for long QT syndrome: Long-term oral potassium improves repolarization in patients with HERG mutations

Long-term oral potassium administration increases serum K+ in patients with LQT2. This can be achieved safely and results in improvement in repolarization.

 

Depressive symptoms and the risk of sudden cardiac death among the elderly

Depressive symptoms increase the risk of SCD, but not that of non-SCD and non-fatal MI among the elderly subjects.


 

QT-interval prolongation in right precordial leads: an additional electrocardiographic hallmark of Brugada syndrome

In accordance with the electrophysiological background, the typical ECG pattern of Brugada syndrome is also characterized by a considerable prolongation of the QT interval in right precordial leads.

Randomized Controlled Trial of Fixed Rate Versus Rate Responsive Pacing After Radiofrequency Atrioventricular Junction Ablation: Quality of Life, Ventricular Refractoriness, and Paced QT Dispersion

Rate responsive pacing results in electrical remodeling of the ventricle following AV junction ablation, but exercise capacity was similar in groups with RR-ON or RR-OFF.

Right Ventricular Outflow Versus Apical Pacing in Pacemaker Patients with Congestive Heart Failure and Atrial Fibrillation

In patients with CHF, LV dysfunction, and chronic AF, RVOT and dual-site RV pacing shorten QRS duration but after 3 months do not consistently improve QOL or other clinical outcomes compared with RVA pacing.

A Randomized Study of Prophylactic Catheter Ablation in Asymptomatic Patients with the Wolff–Parkinson–White Syndrome

Prophylactic accessory-pathway ablation markedly reduces the frequency of arrhythmic events in asymptomatic patients with the Wolff–Parkinson–White syndrome who are at high risk for such events.

Catheter Ablation for Paroxysmal Atrial Fibrillation Segmental Pulmonary Vein Ostial Ablation Versus Left Atrial Ablation

In patients undergoing catheter ablation for PAF, LACA to encircle the PVs is more effective than SOCA.

Report of erectile dysfunction after therapy with beta-blockers is related to patient knowledge of side effects and is reversed by placebo

The knowledge and prejudice about side effects of beta-blockers can produce anxiety, that may cause erectile function.

The Influence of High Versus Normal Impedance Ventricular Leads on Pacemaker Generator Longevity

Implantation of a high impedance lead for ventricular pacing results in a clinically relevant extension of generator longevity.

Death in patients with permanent pacemakers for sick sinus syndrome

After a median follow-up of 33 months, 404 (20%) patients died, including 198 (49%) of noncardiac causes. Patients treated with permanent pacemakers for sinus node dysfunction are elderly and have a substantial mortality rate, with more than half the classifiable deaths being noncardiac.  

Comparison of Standard Cardiopulmonary Resuscitation Versus the Combination of Active Compression-Decompression Cardiopulmonary Resuscitation and an Inspiratory Impedance Threshold Device for Out-of-Hospital Cardiac Arrest

Compared with S-CPR, ACD+ITD CPR significantly improved short-term survival rates for patients with out-of-hospital cardiac arrest. Additional studies are needed to evaluate potential long-term benefits of ACD+ITD CPR.

Orthostatic headaches without CSF leak in postural tachycardia syndrome

Orthostatic headaches are not always caused by CSF leak or supine intracranial hypotension. Occasionally they may be the major clinical manifestation of postural tachycardia syndrome or orthostatic intolerance.

Unexplained syncope in patients with structural heart disease and no documented ventricular arrhythmias: value of electrophysiologically guided implantable cardioverter defibrillator therapy

Syncope per se does not necessarily herald a bad prognosis. PVS identifies high-risk patients. Induction of ventricular fibrillation with double or triple extrastimuli is of limited value. Patients with poor left ventricular function and bad clinical condition benefit most from an ICD.

Long-Term Complication Rates in Ventricular, Single Lead VDD, and Dual Chamber Pacing

Operation time and complication rates of physiological pacing are reduced by VDD pacemaker implantation.

Seven-year outcome in the RITA-2 trial: coronary angioplasty versus medical therapy

An initial strategy of PTCA did not influence the risk of death or MI, but it improved angina and exercise tolerance. Patients considered suitable for PTCA or medical therapy can be safely managed with continued medical therapy, but percutaneous intervention is appropriate if symptoms are not controlled.

Predictors and Clinical Impact of Atrial Fibrillation After Pacemaker Implantation in Elderly Patients Treated with Dual Chamber Versus Ventricular Pacing

DDDR pacing mode protected against the development of AF.

Chronic Experiences with a Single Lead Dual Chamber Implantable Cardioverter Defibrillator System

The first experiences with the new VDD-ICD system show an increase of the specificity to detect ventricular tachycardias to a level comparable to dual chamber ICDs with two leads.

Coincidence of idiopathic ventricular outflow tract tachycardia and atrioventricular nodal reentrant tachycardia

Coincidence of idiopathic outflow tract VT and AVNRT was found in 15% of cases of clinically documented idiopathic VT.

Clinical and electrophysiological characteristics in patients with atrioventricular reentrant and atrioventricular nodal reentrant tachycardia

Patients with AVRT have a lower mean age at arrhythmia symptom onset compared with those with AVNRT and have fewer associated cardiac abnormalities. Clinical presentation is quite similar as well as their outcome after ablation.

Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: A quantitative review

Right ventricular outflow-tract pacing may offer a modest but significant benefit over right ventricular apex pacing in patients selected for pacemaker implantation on the basis of symptomatic bradyarrhythmias.

Effects of Eplerenone, Enalapril, and Eplerenone/Enalapril in Patients With Essential Hypertension and Left Ventricular Hypertrophy The 4E–Left Ventricular Hypertrophy Study

Eplerenone was as effective as enalapril in LVH regression and blood pressure control. The combination of eplerenone and enalapril was more effective in reducing LV mass and systolic blood pressure than eplerenone alone.

Prolonged Atrial Action Potential Durations and Polymorphic Atrial Tachyarrhythmias in Patients with Long QT Syndrome

PolyAT appears to be a specific arrhythmia of LQTS reminiscent of an atrial form of "torsades de pointes."

QRS duration and prediction of mortality in patients undergoing risk stratification for ventricular arrhythmias

Prolonged QRS duration is a strong independent marker of long-term mortality in patients who undergo risk stratification for ventricular arrhythmias.

Non-sustained ventricular tachycardia in hypertrophic cardiomyopathy: an independent marker of sudden death risk in young patients

Non-sustained ventricular tachycardia is associated with a substantial increase in sudden death risk in young patients with HCM.

Sulfonylureas attenuate electrocardiographic ST-segment elevation during an acute myocardial infarction in diabetics

Sulfonylurea therapy appears to attenuate the magnitude of ST-segment elevation during an AMI, resulting in failure to meet criteria for thrombolytic therapy.

Significant gender-related differences in radiofrequency catheter ablation therapy

Women are referred for ablation later than are men, after a longer duration of symptoms, and after having been given more antiarrhythmic drugs.

Comparison of the haemodynamic effects of right ventricular outflow-tract pacing with right ventricular apex pacing: A quantitative review

Right ventricular outflow-tract pacing may offer a modest but significant benefit over right ventricular apex pacing in patients selected for pacemaker implantation on the basis of symptomatic bradyarrhythmias.

QRS duration: a simple marker for predicting cardiac mortality in ICD patients with heart failure

Within subgroups at highest risk of cardiac death, QRS duration—a simple non-invasive index—predicts outcome in ICD recipients in the presence of heart failure.

Ventricular Flutter Induced During Electrophysiologic Studies in Patients with Old Myocardial Infarction: Clinical and Electrophysiologic Predictors, and Prognostic Significance

The prognostic value of inducible ventricular flutter is comparable to that of SMVT.

Are Electrophysiological Studies Needed Prior to Defibrillator Implantation?

Based on these retrospective data, routine electrophysiological study prior to ICD implantation seems to be advisable.

Analysis of Implantable Cardioverter Defibrillator Therapy in the Antiarrhythmics Versus Implantable Defibrillators (AVID) Trial

An appropriate shock was delivered in 53%. The first arrhythmia treated in follow-up was diagnosed as VT (63%), VF (13%), supraventricular tachycardia (18%), unknown arrhythmia (3%), or due to ICD malfunction or inappropriate sensing (3%). Acceleration of an arrhythmia by the ICD occurred in 8%. 

Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically

Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed.

Percutaneous Pericardial Instrumentation for Endo-Epicardial Mapping of Previously Failed Ablations

Epicardial instrumentation and ablation appeared feasible and safe and provided an alternative strategy for the treatment of patients with a variety of arrhythmias. 

Clinical and electrophysiological characteristics in patients with atrioventricular reentrant and atrioventricular nodal reentrant tachycardia

Patients with AVRT have a lower mean age at arrhythmia symptom onset compared with those with AVNRT and have fewer associated cardiac abnormalities. Clinical presentation is quite similar as well as their outcome after ablation. A correct diagnosis by standard ECG is more frequent in AVNRT.

High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias

Complex ventricular arrhythmias do not necessarily represent a benign finding in endurance athletes. An electrophysiological study is indicated for risk evaluation, both by defining inducibility and identifying the arrhythmogenic mechanism. Endurance athletes with arrhythmias have a high prevalence of right ventricular structural and/or arrhythmic involvement. Endurance sports seems to be related to the development and/or progression of the underlying arrhythmogenic substrate.

Proportion and prognosis of healthy people with coved or saddle-back type ST segment elevation in the right precordial leads during 10 years follow-up

The average proportion of healthy subject who had coved or saddle-back type of ST elevation in the right precordial leads without family history of sudden death was 1.22% and the risk of fatal arrhythmias was low (1/393.5 subject-years).

INR Self-Management Permits Lower Anticoagulation Levels After Mechanical Heart Valve Replacement

Early onset INR self-management under oral anticoagulation after mechanical heart valve replacement enables patients to keep within a lower and smaller INR target range.

Effect of Modern Pacing Algorithms on Generator Longevity: A Predictive Analysis

Two algorithms: Capture Management and Search AV, have clinical relevance in the extension of PG longevity.

Radiofrequency Ablation of Probable Atrioventricular Nodal Reentrant Tachycardia in Children with Documented Supraventricular Tachycardia Without Inducible Tachycardia

In selected patients, empiric slow pathway modification may be offered as a potential cure in children with recurrent paroxysmal SVT who are not inducible at electrophysiological study. Elimination of slow pathway conduction may serve as a surrogate endpoint, though is not necessary for long-term success.

Mapping and Ablation of Ventricular Fibrillation Associated With Long-QT and Brugada Syndromes

Triggers from the Purkinje arborization or the right ventricular outflow tract have a crucial role in initiating ventricular fibrillation associated with the long-QT and Brugada syndromes. These can be eliminated by focal radiofrequency ablation.


 

Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era

The common arrhythmia risk variables, particularly the autonomic and standard ECG markers, have limited predictive power in identifying patients at risk of SCD after AMI in the beta-blocking era.

A Randomized Prospective Study of Single Coil Versus Dual Coil Defibrillation in Patients with Ventricular Arrhythmias Undergoing Implantable Cardioverter Defibrillator Therapy

No significant advantage of a dual coil lead system over a single coil system in terms of lead values and defibrillation thresholds.

Ablate and pace revisited: long term survival and predictors of permanent atrial fibrillation

Ablate and pace is associated with a low overall mortality. No predictors of permanent atrial fibrillation were identified, but 48% of patients were still in sinus rhythm at 72 months. These results support the use of dual chamber pacing for paroxysmal atrial fibrillation patients after ablate and pace.

Short QT Syndrome A Familial Cause of Sudden Death

The short QT syndrome is characterized by familial sudden death, short refractory periods, and inducible ventricular fibrillation. It is important to recognize this ECG pattern because it is related to a high risk of sudden death in young, otherwise healthy subjects.

A randomized comparison of atrial and dual-chamber pacing in 177 consecutive patients with sick sinus syndrome: Echocardiographic and clinical outcome

During a mean follow-up of 2.9 ± 1.1 years, DDDR pacing causes increased LA diameter, and DDDR pacing with a short atrioventricular delay also causes decreased LVFS. No changes occur in LA or LV diameters or LVFS during AAIR pacing. Atrial fibrillation is significantly less common during AAIR pacing. 

Comparison of monophasic and biphasic shocks for transthoracic cardioversion of atrial fibrillation

A protocol using monophasic waveform shocks in a 200–360 J sequence has the same efficacy (90%) as a protocol using rectilinear biphasic waveform shocks in a 120–200 J sequence.

A new pacemaker algorithm for the treatment of atrial fibrillation: Results of the Atrial Dynamic Overdrive Pacing Trial (ADOPT)

Overdrive atrial pacing with the AF Suppression Algorithm decreased symptomatic AF burden significantly in patients with sick sinus syndrome and AF. The decrease in relative AF burden was substantial (25%), although the absolute difference was small (2.50% control vs. 1.87% treatment).

Fish Consumption Is Associated With Lower Heart Rates

Fish consumption is associated with decreased heart rate in men. Because heart rate is positively associated with risk of sudden death, this association may explain, at least in part, the lower risk of sudden death among fish consumers.

Effect of 7-Year Infancy-Onset Dietary Intervention on Serum Lipoproteins and Lipoprotein Subclasses in Healthy Children in the Prospective, Randomized Special Turku Coronary Risk Factor Intervention Project for Children (STRIP) Study

The 7-year intervention favorably influenced not only the serum total and LDL cholesterol concentrations but also the LDL particle size in boys.

Effects of initiating carvedilol in patients with severe chronic heart failure. Results from the COPERNICUS study

These data suggest that, in clinically euvolemic patients, the relation of benefit to risk during early initiation of treatment with carvedilol is similar to that seen during long-term therapy with the drug. These findings should provide the reassurance needed to encourage the high levels of use that are warranted by the results of long-term clinical trials.

The risks of β-blockade have been significantly overestimated and the benefits underappreciated. Benefits from carvedilol began to appear about 21 days after its initiation, supporting both the importance of prompt initiation of therapy and the benefit of even low doses of carvedilol (as seen in an earlier study of mild to moderate heart failure). At this point, the safety criteria utilized in COPERNICUS (clinical euvolemia, no intravenous inotrope or vasodilator within the prior 4 days) remain a reasonable guideline for initiation of therapy.

Complications of inappropriate use of spironolactone in heart failure: when an old medicine spirals out of new guidelines

Complications of hyperkalemia, hyponatremia and renal insufficiency were far more common in this study of patients treated with spironolactone in clinical practice compared to patients in the RALES trial. The RALES investigators reported serious hyperkalemia (K≥6.0 mEq/L) in 2% of the patients treated with spironolactone, and did not report less serious degrees of hyperkalemia.  

Inhaled beta-2 adrenergic receptor agonists and primary cardiac arrest

A two-fold increase in the risk of cardiac arrest. The increase risk of cardiac arrest is eliminated by the concomitant use of inhaled steroids.

There are several possible mechanisms by which inhaled β-agonists may increase the risk of cardiac arrest, including: precipitation of ischemia in coronary artery disease; lowering of the ventricular fibrillation threshold; triggering of ventricular tachycardia in susceptible patients (e.g., prior myocardial infarction, idiopathic ventricular tachycardia, long-QT syndrome).

Epinephrine unmasks latent mutation carriers with LQT1 form of congenital long-QT syndrome

Although the sample sizes were fairly small, the results suggest that an epinephrine challenge may be an excellent screening tool for family members of a patient identified to have the LQT1 form of LQTS. If these results are confirmed in larger studies, the decision to institute prophylactic therapy for family members of probands could be based simply on the response to epinephrine, rather than on the more expensive and lengthy process of gene analysis.

Risk stratification in the long-QT syndrome

The risk of cardiac events in the LQTS is affected by the genotype and is the lowest in patients with LQTS1. Asymptomatic patients at highest risk of a cardiac event consist of males or females with LQTS1 and a QTc ≥500 ms, males with LQTS2 and a QTc ≥500 ms, females with LQTS2 (regardless of the QTc) and all patients with LQTS3.

Complete heart block: determinants and clinical impact in patients with hypertrophic obstructive cardiomyopathy undergoing nonsurgical septal reduction therapy

14% developed CHB after the procedure. Multivariate logistic regression analysis showed that female gender, bolus injection of ethanol, injecting more than one septal artery, the presence of left bundle branch block, and first-degree AV block on the baseline ECG are independent predictors of CHB after NSRT. Patients with CHB after NSRT derive similar clinical and hemodynamic benefit to patients who did not require permanent pacing.

Maintenance of sinus rhythm in patients with atrial fibrillation: An AFFIRM substudy of the first antiarrhythmic drug

62% were successfully treated with amiodarone, compared with 23% taking class I agents . In 256 patients randomized between amiodarone and sotalol, 60% versus 38% were successfully treated, respectively. In 183 patients randomized between sotalol and class I agents, 34% versus 23% were successfully treated, respectively.
 

Are lipid-lowering drugs also antiarrhythmic drugs? an analysis of the antiarrhythmics versus implantable defibrillators (AVID) trial

Lipid-lowering therapy is associated with reduction in the probability of VT/VF recurrence, suggesting that part of the benefit of lipid-lowering therapy may be due to an antiarrhythmic effect.

Significant effects of atrioventricular node ablation and pacemaker implantation on left ventricular function and long-term survival in patients with atrial fibrillation and left ventricular dysfunction

Near normalization of LVEF occurred in 29% of study patients, suggesting that AF-induced EF reduction is reversible in many patients. Normal survival in patients with reversible LV dysfunction highlights potential survival benefits of rate control.

Mortality, Morbidity, and Complications in 3,344 Patients with Implantable Cardioverter Defibrillators: Results From the German ICD Registry EURID

The 1-year survival rate was 93.5%. 39.8% had appropriate ICD therapies, 16.2% had inappropriate therapies. When ICDs are used in standard medical care, the 1-year survival rate is high, especially in patients with NYHA Class I and preserved LVEF. However, nearly half of all patients suffer from ICD intervention.

The Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial

For ICD patients, DDDR-70 pacing exhibits no clinical advantage over VVI-40 pacing and may increase CHF and mortality.

Holter Monitoring vs Tilt Testing in the Investigation of Suspected Vasovagal Syncope

Holter monitoring produces a low yield of clinically useful information in the investigation of suspected vasovagal syncope. An HUT test should be considered the primary investigation of choice in such patients.

The Second Vasovagal Pacemaker Study (VPSII)

This double blind randomized trial does not confirm the results of earlier smaller unblinded randomized trials. Because of the weak evidence of efficacy of pacemaker therapy and the risk of complications, pacemaker therapy should not be recommended as first line therapy for patients with recurrent vasovagal syncope.

New Trial Data on Prevention: Potassium and CV Risk in Hope

The combined primary outcome (cardiovascular death, myocardial infarction, or stroke) increased with hypokalemia (22.6% vs 15.5%, p 0.023, hazard ratio 1.44). Hyperkalemia conferred no hazard.

Adverse Effect of Ventricular Pacing on Heart Failure and Atrial Fibrillation Among Patients With Normal Baseline QRS Duration in a Clinical Trial of Pacemaker Therapy for Sinus Node Dysfunction

Ventricular desynchronization imposed by ventricular pacing even when AV synchrony is preserved increases the risk of HF hospitalization and AF in SND with normal baseline QRSd.

Enalapril Decreases the Incidence of Atrial Fibrillation in Patients With Left Ventricular Dysfunction: Insight From the Studies Of Left Ventricular Dysfunction (SOLVD) Trials

AF during the follow-up: 5.4% in the enalapril group and 24% in the placebo group (P<0.0001). Treatment with the ACEi enalapril markedly reduces the risk of development of atrial fibrillation in patients with left ventricular dysfunction.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 Report

Individuals with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as prehypertensive and require health-promoting lifestyle modifications to prevent CVD; Thiazide-type diuretics should be used in drug treatment for most patients with uncomplicated hypertension, either alone or combined with drugs from other classes.

Combined Cardiac Resynchronization and Implantable Cardioversion Defibrillation in Advanced Chronic Heart Failure: The MIRACLE ICD Trial

Cardiac resynchronization improved quality of life, functional status, and exercise capacity in patients with moderate to severe HF, a wide QRS interval, and life-threatening arrhythmias. These improvements occurred in the context of underlying appropriate medical management without proarrhythmia or compromised ICD function.

Estrogen Plus Progestin and the Incidence of Dementia and Mild Cognitive Impairment in Postmenopausal Women: The Women's Health Initiative Memory Study: A Randomized Controlled Trial

Estrogen plus progestin therapy increased the risk for probable dementia in postmenopausal women aged 65 years or older. In addition, estrogen plus progestin therapy did not prevent mild cognitive impairment in these women. These findings, coupled with previously reported WHI data, support the conclusion that the risks of estrogen plus progestin outweigh the benefits.


 

Prognostic Value of Ambulatory Blood-Pressure Recordings in Patients with Treated Hypertension

In patients with treated hypertension, a higher ambulatory systolic or diastolic blood pressure predicts cardiovascular events even after adjustment for classic risk factors including office measurements of blood pressure.

Amiodarone versus implantable cardioverter-defibrillator:randomized trial in patients with nonischemicdilated cardiomyopathy and asymptomatic nonsustained ventricular tachycardia—AMIOVIRT

Mortality and quality of life in patients with NIDCM and NSVT treated with amiodarone or an ICD are not statistically different. There is a trend towards a more beneficial cost profile and improved arrhythmia-free survival with amiodarone therapy.

 

The Australian intervention randomized control of rate in atrial fibrillation trial (AIRCRAFT)

AVJAP for patients with mild to moderately symptomatic permanent AF did not worsen cardiac function during long-term follow-up, and quality of life was improved.

Randomized trial of rate-control versus rhythm-control in persistent atrial fibrillation: The Strategies of Treatment of Atrial Fibrillation (STAF) study

No differences between the two treatment strategies in all end points except hospitalizations. These data suggest that there was no benefit in attempting rhythm-control in these patients with a high risk of arrhythmia recurrence. It remains unclear whether the results in the rhythm-control group would have been better if sinus rhythm had been maintained in a higher proportion of patients, as all but one end point occurred during AF.

 

Anterior-posterior vs. anterior-lateral electrode positions for external cardioversion of atrial fibrillation: a randomized trial

Transthoracic cardioversion is more effective with anterior-posterior electrodes than with anterior-lateral electrodes.

Perspective: With the greater efficacy of biphasic shocks, it is likely that there will be a smaller difference in the success rates of the two electrode configurations than when monophasic shocks are used. Nevertheless, the electrode position does not affect cost or morbidity, and based on the results of this study, it would seem appropriate to use anterior-posterior electrodes whenever feasible in patients undergoing cardioversion of AF.

Acute haemodynamic effects of testosterone in men with chronic heart failure

Administration of testosterone increases cardiac output acutely, apparently via reduction of left ventricular afterload.

Pacemaker prevention therapies for the control of drug-refractory paroxysmal atrial fibrillation

Atrial septal pacing resulted in a marked improvement in AF burden and symptoms. Activation of specific prevention pacing algorithms provided more continuous atrial pacing but had limited and heterogeneous effects on AF burden.

The effect of atrial pacing therapies on atrial tachyarrhythmia burden and frequency: Results of a randomized trial in patients with bradycardia and atrial tachyarrhythmias

This DDDRP pacemaker is safe, has accurate AT/AF detection, and provides ATP with 54% efficacy as defined by the device. The atrial prevention and termination therapies combined did not reduce AT/AF burden or frequency in this patient population.

Implantation of Pacemakers and Implantable Cardioverter Defibrillators in Orally Anticoagulated Patients

In experienced centers, patients requiring treatment with warfarin may undergo implantation of pacemakers or defibrillators with minimal risk despite continuation of anticoagulation.

 

Do airport metal detectors interfere with implantable pacemakers or cardioverter-defibrillators?

In vivo testing of PM and ICD systems showed no EMI with a standard AMDG.

Clinical and electrophysiological differences between patients with arrhythmogenic right ventricular dysplasia and right ventricular outflow tract tachycardia

The tachycardia in the ARVD group displayed features of re-entry in over 80%, but behaved with a triggered automatic basis in 97% with RVOT. Ablation was complete or partial success in 12 (71%) patients with ARVD and ventricular tachycardia (VT) recurred in eight (48%). In the RVOT patients, ablation was a complete success in 97% with recurrent VT in 6%. Long-term success in the RVOT patients was 95% in both patients with and without MRI abnormalities.
The finding of abnormalities on MRI does not have any bearing on arrhythmia mechanism, acute or long-term success of RFA.
 

Is the Left Ventricular Lateral Wall the Best Lead Implantation Site for Cardiac Resynchronization Therapy?

A significant improvement in cardiac function and increase in exercise capacity were observed over time regardless of the LV stimulation sites, either considered singly or grouped as lateral versus septal sites.
 

Cardiac Resynchronization and Implantable Cardioverter Defibrillator Therapy: Preliminary Results from the InSync Implantable Cardioverter Defibrillator Italian Registry

A rate of 12 episodes/100 person-months (95% CI 10-15) was measured in the subgroup of patients with ACC/AHA class I indications, versus two episodes/100 person-months (95% CI 1-5) in the remainder of the population. AThe impact of ICD combined with cardiac resynchronization therapy on arrhythmic profile, mortality, and costs in this subgroup of patients need to be more precisely studied, with a particular focus on the various types of underlying heart disease.
 

Acute and long-term results of radiofrequency ablation of common atrial flutter and the influence of the right atrial isthmus ablation on the occurrence of atrial fibrillation

Acute success rate of 90% and a long-term recurrence rate of 10%. Radiofrequency ablation of common AFL results in a significant reduction in the occurrence of atrial fibrillation.

 

Is the Outcome of Cardiac Resynchronization Therapy Related to the Underlying Etiology?

Non-CAD patients had a greater increase in LVEF and decrease in NYHA functional class than patients with CAD.
 

Flecainide Test in Brugada Syndrome: A Reproducible but Risky Tool

The reproducibility of the flecainide test was 100%. In 4 (18%) of 22 patients major VAs were documented after the end of flecainide infusion.

Safety of a Single Successful Conversion of Ventricular Fibrillation Before the Implantation of Cardioverter Defibrillators

A first successful shock of 14 J may be a sufficient endpoint to allow the implantation of ICDs with the Triad lead configuration, when programming all shocks to 31 J.
 

Relief of Drug Refractory Angina by Biventricular Pacing in Heart Failure

The beneficial effects of CRT on overall cardiac function may include a better control of angina in severely symptomatic patients.

Transfemoral Pediatric Permanent Pacing: Long-term Results

The durability and overall long-term performance of transfemoral leads were excellent.
 

Determinants of Persistent Atrial Fibrillation in Patients with DDD Pacemaker Implantation

Persistent AF was documented in 21 (20.8%) patients. Previous AF attacks, increased left atrial dimension, P maximum value of 120 ms, and a PWD value of 40 ms were associated with a significantly increased risk of persistent AF.

Mechanism of Decrease in the Atrial Potential After Implantation of a Single-Lead VDD Pacemaker: Atrial Histological Changes After Implantation of a VDD Pacemaker Lead in Dogs

Macroscopically, the pacemaker lead was covered with thrombus, and adhered to the atrial wall in 80% of animals. Inflammatory changes developed in the atrial wall after implantation of the VDDPS, and this seemed to be one of the mechanisms for the decrease of the atrial potential of the VDDPS.

Different responses to dobutamine in the presence of carvedilol or metoprolol in patients with chronic heart failure

Patients with congestive heart failure on a non-selective ß adrenoreceptor blocker or ß1 selective blocker responded differently to the inotropic drug dobutamine: the ß1 blockade caused by metoprolol could be counteracted by dobutamine, whereas with carvedilol a low dose of dobutamine increased cardiac output, and a higher dose of dobutamine caused a pressor effect. These findings may be clinically relevant when choosing an inotropic drug.

Quality-of-Life in Patients with Paroxysmal Atrial Fibrillation After Catheter Ablation: Results of Long-Term Follow-Up

Patients with PAF experience a significant improvement in QOL after a successful catheter ablation. In contrast, in patients with recurrence of PAF the QOL showed improvement to a lesser extent and patients experienced ongoing symptoms.

Comparison Between Biventricular Pacing and Single Site Pacing in Patients with Poor Ventricular Function: A Hemodynamic Study

Pacing in patients with heart failure and conduction delay can produce a hemodynamic benefit. There is individual variation in the pacing site that leads to the greatest improvement. In the group as a whole, biventricular and LV pacing produced only modest improvements compared to RV pacing.

Elevations in Ventricular Pacing Threshold with the Use of the Y Adaptor: Implications for Biventricular Pacing

During initial implantation, LV thresholds obtained in a unipolar configuration prior to connecting to the “Y” adaptor were significantly lower than thresholds obtained after connecting to the “Y” adaptor. LV thresholds should be measured in an LV tip to RV ring configuration or ideally in a combined tip (LV and RV) to shared ring configuration in order to accurately assess LV thresholds.

Utility and Safety of Prolonged Temporary Transvenous Pacing Using an Active-Fixation Lead: Comparison with a Conventional Lead

Transvenous temporary pacing using active fixation is safe and is associated with a low dislocation rate and a reduction in pacing related adverse events.

Determination of Repetitive Slow Pathway Conduction for Evaluation of the Efficacy of Radiofrequency Ablation in AVNRT

The presence of repetitive slow pathway conduction identifies an unsuccessful application with a clinically meaningful negative predictive value.

Effect of pacing mode on health-related quality of life in the Canadian Trial of Physiologic Pacing

In this largest randomized assessment of QOL in patients with pacemakers, with the instruments used, there was no significant health-related QOL difference seen between “physiologic” pacing and ventricular pacing.

Sustained ventricular arrhythmias and mortality among patients with acute myocardial infarction: Results from the GUSTO-III trial

Despite thrombolysis, inhospital ventricular arrhythmias are associated with higher 30-day and 1-year mortality rates after acute myocardial infarction, particularly when occurring later during the initial hospitalization. Better therapies are needed to improve outcomes of these arrhythmias.

Temporary Atrial Epicardial Pacing as Prophylaxis Against Atrial Fibrillation after Heart Surgery: A Meta-Analysis

Biatrial overdrive and fixed high-rate pacing and right atrial fixed high-rate pacing reduced the risk of new-onset AF after open heart surgery, and the relative risk reduction is approximately 2.5-fold. These results imply that various pacing algorithms are useful as a nonpharmacologic method to prevent postoperative AF. 

Heart Rate Versus Heart Rate Variability in Risk Prediction after Myocardial Infarction

The prognostic information of HRV is contained completely in heart rate, which carries prognostic information further than that of HRV. This result was independent of beta-blocker treatment.

Novel Brugada SCN5A Mutation Leading to ST Segment Elevation in the Inferior or the Right Precordial Leads

We provide genetic demonstration that Brugada ECG anomalies related to a unique SCN5A mutation can be observed either in the inferior or the right precordial leads.

What characterizes episodes of atrial fibrillation requiring cardioversion? Experience from patients with an implantable atrial cardioverter

Episodes of atrial fibrillation that cause the patient to seek cardioversion are characterized by a high initial ventricular rate and a longer duration than those that go untreated. 

Electrical Resynchronization: A Novel Therapy for the Failing Right Ventricle

Atrioventricular pacing in patients with RBBB and RV dysfunction augments RV and systemic performance. RV resynchronization is a promising novel therapy for patients with RV failure.

Transendocardial, Autologous Bone Marrow Cell Transplantation for Severe, Chronic Ischemic Heart Failure

The present study demonstrates the relative safety of intramyocardial injections of bone marrow–derived stem cells in humans with severe heart failure and the potential for improving myocardial blood flow with associated enhancement of regional and global left ventricular function.

Effects of high-dose furosemide and small-volume hypertonic saline solution infusion in comparison with a high dose of furosemide as bolus in refractory congestive heart failure: Long-term effects

This treatment is effective and well tolerated, improves the quality of life through the relief of signs and symptoms of congestion, and may delay more aggressive treatments. The effects were also beneficial in a long period for mortality reduction (55% vs 13% survival rate) and for clinical improvement.

Cardiac Resynchronization and Death From Progressive Heart Failure. A Meta-analysis of Randomized Controlled Trials

Cardiac resynchronization reduces mortality from progressive heart failure in patients with symptomatic left ventricular dysfunction. This finding suggests that cardiac resynchronization may have a substantial impact on the most common mechanism of death among patients with advanced heart failure. Cardiac resynchronization also reduces heart failure hospitalization and shows a trend toward reducing all-cause mortality.

Two-decade-long trends (1975-1997) in the incidence, hospitalization, and long-term death rates associated with complete heart block complicating acute myocardial infarction: A community-wide perspective

Overall, CHB developed in 5.0% of patients with AMI. The incidence of CHB complicating AMI has declined with time. The hospital prognosis of patients in whom CHB developed has improved, but these patients remain at an increased risk of hospital mortality. The long-term prognosis of patients with inferior MI and CHB is similar to that of patients in whom CHB did not develop. Patients with anterior MI and CHB may be at an increased risk of long-term mortality.

Implantable Cardioverter Defibrillator in High-Risk Long QT Syndrome Patients

There was 1 (1.3%) death in 73 ICD patients followed an average of 3 years, whereas there were 26 deaths (16%) in non-ICD patients during mean 8-year follow-up (P = 0.07 from log rank test from Kaplan-Meier curves). ICDs provide an important therapeutic option to prevent sudden arrhythmic death in high-risk LQTS patients.

Effectiveness of implantable defibrillators for preventing arrhythmic events and death: A meta-analysis

The primary and secondary prevention trials showed a significant benefit of the ICD with respect to arrhythmic death, with relative risks (RR) of 0.34 and 0.50, respectively (both p < 0.001). Although the ICD decreases the risk of arrhythmic death, its impact on all-cause mortality is related to the underlying risk of arrhythmia-related death relative to competing causes. Given the cost of the device strategy, policies of targeted intervention based on the future risk of arrhythmia are warranted.

Natural History of Brugada Syndrome: The Prognostic Value of Programmed Electrical Stimulation of the Heart

Symptomatic patients were more frequently inducible [126/180 (70%)] than asymptomatic individuals [91/263 (34%); P = 0.0001 ]. Males were more frequently inducible than females (54% vs 32%, P < 0.0001 ). Inducible individuals had a longer HV interval than noninducible patients ( 50 ± 12 msec vs 46 ± 10 msec, P < 0.002 ). Inducibility of sustained ventricular arrhythmias during programmed ventricular stimulation of the heart is a good predictor of outcome in Brugada syndrome.

Clinical and Electrophysiologic Predictors of Ventricular Tachyarrhythmia Recurrence in Patients with Implantable Cardioverter Defibrillators

Inducibility of sustained VT/VF post-ICD implant (P < 0.001) and sustained VT as the presenting arrhythmia (P = 0.02) were independent predictors of spontaneous VT/VF recurrence.

Calcium antagonists reduce cardiovascular complications after cardiac surgery: A meta-analysis

Use of CAs during cardiac surgery significantly reduced rates of MI, ischemia, and SVT. Further study using large RCTs is justified.

A meta-analysis of randomized controlled trials comparing coronary artery bypass graft with percutaneous transluminal coronary angioplasty: one- to eight-year outcomes

When compared with PTCA, CABG is associated with a lower five-year mortality, less angina, and fewer revascularization procedures. For patients with multivessel disease, CABG provided a survival advantage at five to eight years, and for diabetics, a survival advantage at four years. The addition of stents reduced the need for repeat revascularization by about half.

Efficacy and tolerability of eplerenone and losartan in hypertensive black and white patients

The antihypertensive effect of eplerenone was equal in black and white patients and was superior to losartan in black patients.

Nitroprusside in Critically Ill Patients with Left Ventricular Dysfunction and Aortic Stenosis

Nitroprusside rapidly and markedly improves cardiac function in patients with decompensated heart failure due to severe left ventricular systolic dysfunction and severe aortic stenosis. It provides a safe and effective bridge to aortic-valve replacement or oral vasodilator therapy in these critically ill patients.

Uric Acid and Survival in Chronic Heart Failure. Validation and Application in Metabolic, Functional, and Hemodynamic Staging

High serum UA levels are a strong, independent marker of impaired prognosis in patients with moderate to severe CHF. The relationship between serum UA and survival in CHF is graded.

An Association between Atherosclerosis and Venous Thrombosis

The odds ratios for carotid plaques in patients with spontaneous thrombosis, as compared with patients with secondary thrombosis and with controls, were 2.3 (95 percent confidence interval, 1.4 to 3.7) and 1.8 (95 percent confidence interval, 1.1 to 2.9), respectively. There is an association between atherosclerotic disease and spontaneous venous thrombosis. Atherosclerosis may induce venous thrombosis, or the two conditions may share common risk factors.

Atrial High Rate Episodes Detected by Pacemaker Diagnostics Predict Death and Stroke. Report of the Atrial Diagnostics Ancillary Study of the MOde Selection Trial (MOST)

AHRE detected by pacemakers in patients with SND identify patients that are more than twice as likely to die or have a stroke, and 6 times as likely to develop atrial fibrillation as similar patients without AHRE.

Prevention of Heart Failure in Patients in the Heart Outcomes Prevention Evaluation (HOPE) Study

Ramipril reduced new-onset heart failure rate from 11.5% to 9.0%.

Enalapril Reduces the Incidence of Diabetes in Patients With Chronic Heart Failure. Insight From the Studies Of Left Ventricular Dysfunction (SOLVD)

Enalapril remained the most powerful predictor for risk reduction of developing diabetes (hazard ratio, 0.22);

Sotalol testing unmasks altered repolarization in patients with suspected acquired long-QT-syndrome—a case-control pilot study using i.v. sotalol

Controlled exposure to sotalol successfully identifies patients with normal QTc intervals but altered myocardial repolarization. This may be useful for clarifying diagnosis and pathogenesis of acquired Long-QT-Syndrome.

 

Long QTc predicts future cardiac death in stroke survivors

Stroke survivors with a prolonged QTc in lead V6 are still at a high risk of cardiac death and may need more intensive investigations and treatments than are currently routine practice.

Head-up tilt test with clomipramine challenge in vasovagal syndrome—a new tilt testing protocol

The predictive accuracy of Clom-HUT increased compared to Conventional HUT from 58 to 86%, respectively.

The results indicate an increased responsiveness of central serotonergic neural system in subjects with vasovagal syndrome, the activation of which leads to sympathetic withdrawal. The use of clomipramine infusion during tilt test seems to improve considerably its diagnostic value.

Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration

Hypertrophic cardiomyopathy is a benign disease in an unselected population with a low incidence of cardiac death. Syncope was associated with a higher incidence of SCD and patients with a significant LVOT obstruction were more susceptible to clinical deterioration.

Development and validation of a simple risk score to predict the need for permanent pacing after cardiac valve surgery

Preoperative right bundle branch block (odds ratio [OR], 3.6; 95% confidence interval [CI], 2.3 to 5.7) and multivalve surgery that included the tricuspid valve (OR, 3.7; 95% CI, 2.3 to 6.1) were the strongest independent predictors of PPM, while multivalve surgery that did not include the tricuspid valve (OR, 2.1; 95% CI, 1.3 to 3.3), preoperative left bundle branch block (OR, 2.0; 95% CI, 1.3 to 2.9), preoperative PR interval >200 ms (OR, 1.9; 95% CI, 1.3 to 3.0), prior valve surgery (OR, 1.8, 95% CI, 1.2 to 2.7), and age >70 years (OR, 1.4; 95% CI, 1.04 to 2.0) also predicted PPM. A risk score from 0 to 6 identified patients in the VG with incidences of PPM of 1.9%, 5.2%, 8.7%, 11.5%, 21%, 36%, and 50%, respectively.

Oral Health and Peripheral Arterial Disease

Incident tooth loss was significantly associated with PAD, especially among men with periodontal diseases. The results support a potential oral infection–inflammation pathway. 

Dual-chamber pacing or ventricular backup pacing in patients with an implantable defibrillator: the Dual Chamber and VVI Implantable Defibrillator (DAVID) Trial.

For patients with standard indications for ICD therapy, no indication for cardiac pacing, and an LVEF of 40% or less, dual-chamber pacing offers no clinical advantage over ventricular backup pacing and may be detrimental by increasing the combined end point of death or hospitalization for heart failure.

Fibrinolysis of mechanical prosthetic valve thrombosis: A single-center study of 127 cases

FT is effective in most cases of PHVT, regardless of prosthesis or site involved. However, embolism, hemorrhage, and death were not uncommon after lytic therapy of left-sided PHVT, limiting its application to patients at high risk with alternative treatment.

Frequent Ventricular Ectopy after Exercise as a Predictor of Death

Frequent ventricular ectopy during recovery after exercise is a better predictor of an increased risk of death than ventricular ectopy occurring only during exercise.

Asymptomatic or "Silent" Atrial Fibrillation, Frequency in Untreated Patients and Patients Receiving Azimilide

Asymptomatic atrial fibrillation is common in untreated patients with a history of symptomatic atrial fibrillation (and is likely underestimated by this analysis). Asymptomatic atrial fibrillation was recorded in 50 (17%) within 6 months. Azimilide may reduce the occurrence of this silent arrhythmia.

A Comparison of Outcomes with Angiotensin-Converting–Enzyme Inhibitors and Diuretics for Hypertension in the Elderly

Initiation of antihypertensive treatment involving ACE inhibitors in older subjects, particularly men, appears to lead to better outcomes than treatment with diuretic agents, despite similar reductions of blood pressure.

Double-blind, placebo-controlled, randomized trial of prophylactic metoprolol for reduction of hospital length of stay after heart surgery: The -Blocker Length Of Stay (BLOS) study

Prophylactic metoprolol reduces the risk of AF after heart surgery. It does not reduce hospital length of stay. Although it is cost effective for the reduction of AF, it did not reduce the overall cost of care.

Usefulness of invasive electrophysiologic testing to stratify the risk of arrhythmic events in asymptomatic patients with Wolff-Parkinson-White pattern: Results from a large prospective long-term follow-up study

In asymptomatic WPW subjects, EPT may be a valuable tool to stratify the risk of symptomatic and fatal arrhythmic events.

Amiodarone and the risk of bradyarrhythmia requiring permanent pacemaker in elderly patients with atrial fibrillation and prior myocardial infarction

The use of amiodarone in elderly patients with AF and a previous MI increases the risk of bradyarrhythmia requiring a permanent pacemaker. Greater risk in women. Digoxin was the only other medication associated with an increased risk of pacemaker insertion.

Short-Term Heart Rate Variability Strongly Predicts Sudden Cardiac Death in Chronic Heart Failure Patients

Reduced short-term LFP during controlled breathing is a powerful predictor of sudden death in patients with CHF that is independent of many other variables. These results refine the identification of patients who may benefit from prophylactic implantation of a cardiac defibrillator.

Atrial fibrillation: relation between clinical risk factors and transoesophageal echocardiographic risk factors for thromboembolism

There is a close relation between clinical risk factors and TOE markers of a thrombogenic milieu. In addition, TOE examination allows for the identification of patients with a thrombogenic milieu without clinical risk factors.

Mitral annular calcification: a marker of severe coronary artery disease in patients under 65 years old

In patients aged  65 years, mitral annular calcification is associated with an increased prevalence of severe obstructive coronary artery disease. It may serve as a useful echocardiographic marker for the presence of obstructive coronary artery disease, especially when associated with anginal symptoms.

Prognostic value of QT interval and QT dispersion in patients with left ventricular systolic dysfunction: Results from a cohort of 2265 patients with an ejection fraction of 40%

Both QTc prolongation and increased QTd are associated with higher mortality rate in patients with moderate and severe LV dysfunction.

Mechanism of syncope in patients with positive adenosine triphosphate tests

In patients with adenosine-sensitive syncope, the mechanism of syncope is heterogeneous, although bradycardia is the most frequent finding. Adenosine triphosphate–induced AV block predicts AV block as the mechanism of spontaneous syncope in only a few tilt-negative patients.

Current Use of Unopposed Estrogen and Estrogen Plus Progestin and the Risk of Acute Myocardial Infarction Among Women With Diabetes

In women without a recent MI, use of estrogen plus progestin was associated with decreased risk of MI. However, HRT was associated with increased risk of MI in women with history of a recent MI.

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