Ranolazine enhances the antiarrhythmic activity of amiodarone by accelerating conversion of new-onset atrial fibrillation after cardiac surgery.

Ranolazine is a relatively novel antiischemic/antianginal compound with antiarrhythmic properties. We investigated its ability to shorten the time to conversion of postoperative atrial fibrillation (POAF) when added to amiodarone after coronary artery bypass graft (CABG) surgery. In this prospective, randomized, allocation-concealed, single-blind, single-site clinical trial, we enrolled consecutive eligible patients who developed POAF after elective on-pump CABG surgery. Participants were randomized to receive either ranolazine 375 mg twice daily orally plus intravenous amiodarone (active group) or intravenous amiodarone alone (control group). We enrolled 41 patients; 20 in the active and 21 in the control group. There were no significant differences between the groups in terms of age, procedural duration, extracorporeal circulation time, and aortic cross-clamp time. Mean time of conversion was significantly shorter in the active group (19.9 ± 3.2 vs 37.2 ± 3.9 hours, P < .001), suggesting that compared to amiodarone alone, the ranolazine-amiodarone combination had a superior antiarrhythmic effect against POAF.

Transesophageal echocardiography for detection of a papillary fibroelastoma of the aortic valve.

Papillary fibroelastoma (PF) is a benign cardiac tumor, typically attached to the cardiac valves. It is usually found incidentally at autopsy or surgery. It is rarely symptomatic, but can cause myocardial infarction, cerebral infarction and systemic embolism, even in young patients, and sometimes results in sudden death. We report on a case of a PF attached to the nodulus arantii of the left coronary cusp in a 56-year-old woman. She was referred to our institution due to a non ST-elevation myocardial infarction diagnosed by troponin positive-test. No other embolic source was identified. Diagnosis was obtained by two-dimensional echocardiography and confirmed by transesophageal echocardiography. After complete surgical removal of the tumor, we reconstructed the left coronary cusp with autologous pericardium. The histology revealed the diagnosis of a PF. Intraoperative transesophageal echocardiography confirmed complete restoration of aortic valve cusp coaptation. The clinical course was uneventful.

Surgical feasibility of the injection of fibrin sealant in cardiac fat pads to reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting or valve surgery: a pilot study.

OBJECTIVE: : Atrial fibrillation (AF) is the most common complication following coronary artery bypass grafting or valve surgery.The autonomic nervous system is an important determinant in the development of AF. We have assessed the role of injection of fibrin sealant (FS) as a method to modify conduction in the fad pads, to mimic temporary denervation and to reduce the incidence of postoperative AF in patients undergoing coronary artery bypass grafting or valve surgery. PATIENTS AND METHODS: : Twenty eligible patients who underwent coronary bypass grafting or aortic valve surgery in our Institution were included in this pilot - study.Detection of AF after surgical intervention was based on patient symptomatology and on daily electrocardiograms obtained on all patients. Telemetry was used in all patients for the entire hospitalization period. RESULTS: : 20% of the studied population (n = 4) developed postoperative AF. At the time of discharge one patient (5%) had persistent AF.Postoperative mortality was 5% (n = 1) and not cardiac related. None of the patients required permanent pacemaker implantation. CONCLUSIONS: : This first human study of FS injected into the anterior fad pads following low to moderate risk open heart surgery shows, that this procedure is safe and feasible. Moreover, CM -1 injection appears to reduce the need for postoperative intervention and/or treatment of AF by diminishing its incidence.