Subject(s)
Antiviral Agents/adverse effects , Arrhythmias, Cardiac/chemically induced , Coronavirus Infections/drug therapy , Heart Rate/drug effects , Hydroxychloroquine/adverse effects , Pneumonia, Viral/drug therapy , Action Potentials/drug effects , Aged , Antiviral Agents/pharmacokinetics , Arrhythmias, Cardiac/diagnosis , Arrhythmias, Cardiac/physiopathology , COVID-19 , Cardiotoxicity , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Humans , Hydroxychloroquine/pharmacokinetics , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment Outcome , COVID-19 Drug TreatmentABSTRACT
Dofetilide is a class III antiarrhythmic agent approved by the Food and Drug Administration for the conversion of atrial fibrillation and atrial flutter and maintenance of sinus rhythm in symptomatic patients with persistent arrhythmia. Drug trials showed neutral mortality in post-myocardial infarction patients and those with heart failure. This is a review of postmarket data, including real-world efficacy and safety in a variety of populations. Dofetilide has been used off-label with success in patients with paroxysmal atrial fibrillation and atrial flutter, as well as atrial tachycardia and ventricular tachycardia. The real-world acute conversion rate of atrial fibrillation and atrial flutter is higher than that reported in clinical trials. Dofetilide has an acceptable safety profile when initiated (or reloaded) under hospital monitoring and dosed according to creatinine clearance. Dofetilide is well tolerated and a good choice for patients with acceptable renal function and a normal QT interval, especially if atrioventricular nodal blockade needs to be avoided.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/drug therapy , Atrial Flutter/drug therapy , Heart Conduction System/drug effects , Heart Rate/drug effects , Phenethylamines/therapeutic use , Potassium Channel Blockers/therapeutic use , Sulfonamides/therapeutic use , Anti-Arrhythmia Agents/adverse effects , Anti-Arrhythmia Agents/pharmacokinetics , Atrial Fibrillation/diagnosis , Atrial Fibrillation/mortality , Atrial Fibrillation/physiopathology , Atrial Flutter/diagnosis , Atrial Flutter/mortality , Atrial Flutter/physiopathology , Clinical Decision-Making , Heart Conduction System/physiopathology , Humans , Patient Selection , Phenethylamines/adverse effects , Phenethylamines/pharmacokinetics , Potassium Channel Blockers/adverse effects , Potassium Channel Blockers/pharmacokinetics , Risk Factors , Sulfonamides/adverse effects , Sulfonamides/pharmacokinetics , Treatment OutcomeABSTRACT
Aims: To compare the long-term outcomes of standard ablation of stable ventricular tachycardia (VT) vs. substrate modification, and of complete vs. incomplete substrate modification in patients with structural heart disease (SHD) presenting with VT. Methods and results: An electronic search was performed using major databases. The main outcomes were a composite of long-term ventricular arrhythmia (VA) recurrence and all-cause mortality of standard ablation of stable VT vs. substrate modification, and long-term VA recurrence in complete vs. incomplete substrate modification. Six studies were included for the comparison of standard ablation of stable VT vs. substrate modification, with a total of 396 patients (mean age 63 ± 10 years, 87% males), and seven studies were included to assess the impact of extensive substrate modification, with a total of 391 patients (mean age 64 ± years, 90% males). More than 70% of all the patients included had ischaemic cardiomyopathy. Substrate modification was associated with decreased composite VA recurrence/all-cause mortality compared to standard ablation of stable VTs [risk ratio (RR) 0.57, 95% confidence interval (CI) 0.40-0.81]. Complete substrate modification was associated with decreased VA recurrence as compared to incomplete substrate modification (RR 0.39, 95% CI 0.27-0.58). Conclusion: In patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification.
Subject(s)
Ablation Techniques , Tachycardia, Ventricular/surgery , Ablation Techniques/adverse effects , Ablation Techniques/mortality , Adult , Aged , Cause of Death , Chi-Square Distribution , Disease-Free Survival , Female , Humans , Male , Middle Aged , Odds Ratio , Recurrence , Risk Factors , Tachycardia, Ventricular/diagnosis , Tachycardia, Ventricular/mortality , Tachycardia, Ventricular/physiopathology , Time Factors , Treatment OutcomeABSTRACT
Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice today. For those who present with it, one of the most major risks associated with the condition is stroke. AF is associated with a fivefold increased risk of stroke and thromboembolism. Oral anticoagulation has been the cornerstone of stroke prevention in patients with AF. In some individuals who exhibit a higher risk of bleeding, other alternatives for stroke prevention have been sought, including the use of left atrial appendage occlusion devices and surgical exclusion of the left atrial appendage. Catheter ablation is an important treatment strategy in those patients for whom a rhythm control strategy has been selected. This article reviews some of the available anticoagulant drug options and their use prior to, during, and after catheter ablation.
ABSTRACT
PURPOSE: Little is known about the usefulness and safety of vascular closure devices (VCDs) in electrophysiological procedures. We present a retrospective analysis of our experience assessing the utility and outcomes of collagen vascular closure device (Angioseal) in patients that required periprocedural anticoagulation and multiple vascular access sites. METHODS: An retrospective chart review of patients who have undergone the deployment of VCD following electrophysiological procedures. RESULTS: In 26 patients (16 males, age 57 ± 15 years, weight 96 ± 21 kg), a total of 76 VCD were deployed. Seventy-three VCDs in femoral veins (right or left) and three in femoral artery. The mean number of VCD per patient was 3 (range, 2-4). VCD was successfully deployed in 75 out of 76 access sites. One patient was noted to have ecchymosis in both groins during follow-up visit. No other complications were noted. CONCLUSIONS: We provide evidence that a collagen plug-based VCD designed for arterial closure can be safely and effectively used to close multiple venous accesses even in the same vein. This can be accomplished with a venotomy size up to 2 Fr larger than the size of the closure device.
Subject(s)
Electrophysiologic Techniques, Cardiac , Vascular Closure Devices , Anticoagulants/administration & dosage , Collagen , Female , Hemostatic Techniques , Humans , Male , Middle Aged , Retrospective Studies , Treatment OutcomeABSTRACT
The incidence of hypertension is increasing every year. Blood pressure (BP) control is an important therapeutic goal for the slowing of progression as well as for the prevention of Cardiovascular disease. The management of hypertension in the high cardiovascular risk population remains a real challenge as the population continues to age, the incidence of diabetes increases, and more and more people survive acute myocardial infarction. We will review hypertension management in the high cardiovascular risk population: patients with coronary heart disease (CHD) and heart failure (HF) as well as in diabetic patients.
ABSTRACT
An 84 year-old man with history of recurrent dizziness presented with first degree atrio-ventricular block (1° AVB) and periods of 2:1 AVB. An electrophysiological study revealed a predominant 1:1 AV conduction with markedly prolonged AH interval and frequent His bundle extrasystoles (H). A properly timed H could induce periods of 2:1 AV nodal block and 1:1 AV conduction could only resume following another properly timed H. Procainamide suppressed H. However, because of persistence of the patient symptoms, a permanent pacemaker was eventually inserted. The case illustrates a hitherto not described manifestation of H.