Meditation and Cardiovascular Risk Reduction: A Scientific Statement From the American Heart Association.

Despite numerous advances in the prevention and treatment of atherosclerosis, cardiovascular disease remains a leading cause of morbidity and mortality. Novel and inexpensive interventions that can contribute to the primary and secondary prevention of cardiovascular disease are of interest. Numerous studies have reported on the benefits of meditation. Meditation instruction and practice is widely accessible and inexpensive and may thus be a potential attractive cost-effective adjunct to more traditional medical therapies. Accordingly, this American Heart Association scientific statement systematically reviewed the data on the potential benefits of meditation on cardiovascular risk. Neurophysiological and neuroanatomical studies demonstrate that meditation can have long-standing effects on the brain, which provide some biological plausibility for beneficial consequences on the physiological basal state and on cardiovascular risk. Studies of the effects of meditation on cardiovascular risk have included those investigating physiological response to stress, smoking cessation, blood pressure reduction, insulin resistance and metabolic syndrome, endothelial function, inducible myocardial ischemia, and primary and secondary prevention of cardiovascular disease. Overall, studies of meditation suggest a possible benefit on cardiovascular risk, although the overall quality and, in some cases, quantity of study data are modest. Given the low costs and low risks of this intervention, meditation may be considered as an adjunct to guideline-directed cardiovascular risk reduction by those interested in this lifestyle modification, with the understanding that the benefits of such intervention remain to be better established. Further research on meditation and cardiovascular risk is warranted. Such studies, to the degree possible, should utilize randomized study design, be adequately powered to meet the primary study outcome, strive to achieve low drop-out rates, include long-term follow-up, and be performed by those without inherent bias in outcome.

Meditation and coronary heart disease: a review of the current clinical evidence.

BACKGROUND: Chest pain from coronary heart disease (CHD) accounts for more than 8 million emergency department visits every year in the United States, emphasizing the need for cardiovascular (CV) interventions to help reduce this high number. Meditation--a state of contemplation, concentration, and reflection--has the potential to help decrease CV disease. METHODS: This article reviews the available data regarding the effects of meditation on various aspects of CV health. RESULTS: During the past few decades, multiple studies have demonstrated the beneficial effects of meditation on various CV risk factors. In addition to decreasing CV mortality, meditation has also been shown to improve conditions such as hypertension, type 2 diabetes mellitus, dyslipidemia, and high cortisol levels. Still unclear is how current medical therapies impact overall CHD in comparison to meditation techniques. CONCLUSION: Prospective trials are needed to study the effects of meditation on CV risk factors, to provide guidelines for daily meditation practice, and to determine the efficacy of meditation compared to current pharmacologic therapies.

Fragmented QRS complexes-a novel but underutilized electrocardiograhic marker of heart disease.

The electrocardiogram is the mainstay approach for diagnosing a myocardial infarction (MI). The diagnosis of an old MI and the identification of myocardial scar via the electrocardiogram are difficult because there are no other specific signs for a non-Q-wave MI. In this article, we will review the fragmented QRS and its role in identifying myocardial scar and depolarization abnormalities in patients with coronary artery disease.

Initial experience with a novel remote-guided magnetic catheter navigation system for left ventricular scar mapping and ablation in a porcine model of healed myocardial infarction.

OBJECTIVE: This study examined the feasibility of using a remote magnetic catheter navigation system (MNS) in concert with an EAM system to perform detailed left ventricular scar mapping and ablation in a porcine model of healed myocardial infarction. BACKGROUND: Substrate-based catheter ablation of ventricular tachycardia (VT) involves detailed electroanatomical mapping (EAM) of the ventricles. While a safe and effective procedure, VT ablation is nonetheless uncommonly performed, due in part to the technical challenges related to ventricular mapping. METHODS: Using a prototype EAM system (CARTO-RMT), seven chronically infarcted swine were mapped using either: (i) a standard manually manipulated catheter or (ii) a magnetic remotely manipulated (Niobe) catheter. A total of 191 +/- 54 and 221 +/- 64 points were acquired to map the chamber either manually or remotely, respectively. RESULTS: Procedure times were longer remotely (94 +/- 22 vs. 59 +/- 19 minute, P = 0.004; and 27 +/- 8 vs. 18 +/- 3 sec/point, P = 0.04), but this became less apparent with increased operator experience. However, the fluoroscopy time was significantly shorter with remote mapping (56 +/- 56 vs. 244 +/- 67 sec/map, P = 0.03). The calculated scar size was comparable between the two methods (16.3 +/- 4.9 vs. 16.4 +/- 4.8 cm2, P = 0.37). Pathologic examination confirmed that the MNS was able to precisely deliver radiofrequency lesions to the scar borders. Using the MNS, the error to reach an evenly distributed set of endocardial targets was 6.6 +/- 3.6 mm and 4.6 +/- 2.0 mm, using transseptal and retrograde approaches, respectively. CONCLUSIONS: Ventricular mapping using this remote navigation paradigm is technically possible and requires minimal fluoroscopy exposure, potentially facilitating ventricular substrate mapping and ablation.

Treating atrial fibrillation. What is the consensus now?

Atrial fibrillation (AF) is a common cardiac arrhythmia, especially in elderly persons. Current recommendations outline pharmacologic and interventional therapies designed to minimize the risk of stroke and other morbidities that can accompany this condition. In this article, Drs Basu Ray and Heist review treatment options for cardioversion and control of rate and rhythm and make suggestions for best management in patients with chronic or intermittent AF.

Implanted defibrillators and primary prevention of sudden cardiac death: where are we today?

Implanted defibrillators have become a mainstream therapy for the prevention of sudden cardiac death (SCD) from ventricular tachyarrhythmias in patients with chronic coronary artery disease. A decade of studies has confirmed the superiority of ICDs over antiarrhythmic drug therapy in prolonging the life of patients with a prior history of sustained VT or VF. Furthermore, recent studies have examined the role of ICD therapy in the primary prophylaxis against sudden death in patients considered at high risk for ventricular tachyarrhythmias. These studies have revealed that in selected patients with the substrate of chronic coronary artery disease and a ventricular scar, ICDs lead to important relative and absolute reductions in mortality in such patients without a prior history of VT or VF. Clinicians caring for patients with chronic coronary artery disease (CAD) and severe LV dysfunction, who are at a risk of sudden cardiac death, need to carefully consider this information when managing this patient population.

Preventing sudden death and the use of prophylactic implanted defibrillators.

Implanted defibrillators have become mainstream therapy for the prevention of sudden cardiac death from ventricular tachyarrhythmias. A decade of studies has confirmed the superiority of ICDs over antiarrhythmic drug therapy in prolonging the life of patients with a prior history of sustained VT or VF. More recent studies have compared ICD therapy to drugs or no antiarrhythmic therapy as 'primary prophylaxis' in patients considered at high risk for sudden death or with prior MIs. In selected patients, ICDs lead to important relative and absolute reductions in mortality in patients with no prior history of sustained VT or VF. Clinicians need to carefully consider these studies in their management of patients with CAD and severe LV dysfunction.