[The efficacy of oral treatment with flecainide for paroxysmal atrial fibrillation: correlation with plasma concentration]. / Efficacia del trattamento orale con flecainide nella fibrillazione atriale parossistica: correlazione con le concentrazioni plasmatiche.

In the acute treatment of paroxysmal atrial fibrillation several drugs can be used. The aim of our work was to assess the efficacy of a single oral dose of flecainide in the conversion to sinus rhythm by correlating this data with flecainide plasma concentration. We have considered 37 patients affected by paroxysmal atrial fibrillation (for more than 8 hours) randomly assigned to the following two groups: group A, 19 patients, mean age 44.4 +/- 1.9 years) treated with flecainide (200 mg) and control group B (18 patients, mean age 46.6 +/- 1.8 years). This was done in order to point out any possible overlap between pharmacological and spontaneous conversion to sinus rhythm. In all patients, the following were performed: a Holter recording (524 hours) to evaluate the time of conversion to sinus rhythm (t-conversion to sinus rhythm), a determination of flecainide plasma concentration (after 150 flecainide administration) an Rx, an Echo-2D/Doppler test and an estimation of thyroid function. The Rx, the Echo-2D/Doppler and the endocrinological data in the 2 groups did not show any significant differences. We obtained a conversion to sinus rhythm in all but one of the group A patients (time of conversion to sinus rhythm 162 +/- 83 min) and in just 5 group B patients (time of conversion to sinus rhythm 1118 +/- 125 min) (time of conversion to sinus rhythm A vs B p less than .001).(ABSTRACT TRUNCATED AT 250 WORDS)

[Early peak of CPK in acute myocardial infarct: a marker of clinical instability?]. / II picco precoce della CPK in corso di IMA: marker di instabilità clinica?

The evaluation of the CPK-peak time (CPK-p) during Acute Myocardial Infarction (AMI) is now considered as a reliable method to identify ischemic myocardial tissue reperfusion both spontaneous and pharmacologically-induced. The purpose of this study is to assess the clinical significance of this index over a non selected group of patients (pts) affected by a first episode of AMI looking for some variables possibly connected with it. This study includes 114 pts hospitalized in our Unit Coronary Care (UCC) and diagnosed as affected by AMI and not treated with anticoagulant and/or fibrinolytic drugs. They were divided according to CPK-p into 2 groups: group A (23 pts, 18M 5F, mean age 64.2 +/- 10.1y; CPK-p 11.9 +/- 3.3h, AMI Anterior 14/AMI Inferior 9) and group B (91 pts, 85M 6F, mean age 64 +/- 10.3y; CPK-p 25.7 +/- 4.5h, AMI Anterior 50/AMI Inferior 41). Moreover, a third group C has been studied including pts with similar clinical characteristics who underwent thrombolysis by intravenous infusion of Streptokinase (48 pts, 39M 9F, mean age 62.7 +/- 10.6y; CPK-p 15.2 +/- 7h, AMI Anterior 28/AMI Inferior 20). For each pt CKP-p has been evaluated as well as the pre-UCC time (T-pc), the maximum value of released CPK (CPK-max), the incidence of new coronary events such as angina, re-AMI, sudden death detected between the 1st (NEC-I) and the 6th month (NEC-II) after the acute event.(ABSTRACT TRUNCATED AT 250 WORDS)