Variation of inflammatory indexes after electrical cardioversion of persistent atrial fibrillation. Is there an association with early recurrence rates?

Inflammation has been recently implicated in the pathophysiology of atrial fibrillation (AF). The aim of this study was to examine the variation of inflammatory indexes during the first week after successful electrical cardioversion of persistent AF. Successive measurements of white blood cell (WBC) count, C-reactive protein (CRP) and fibrinogen levels were performed in 30 cardioverted patients. At the end of the 7-day follow-up period, AF had recurred in 30% of patients. A significant variance was found in serial measurements of fibrinogen levels in the two groups (non-relapse and relapse, p = 0.005). Fibrinogen levels increased significantly in patients who relapsed into AF, but remained stable in patients who remained in sinus rhythm. In the latter patients, CRP values tended to decrease post-cardioversion, but WBC count was significantly lower (p < 0.001) on the 7th day (6083 +/- 1335), compared with baseline values (6648 +/- 1395). The variation of inflammatory indices post-cardioversion might have prognostic implications with regard to sinus rhythm maintenance.

Metabolic management of coronary heart disease: adjunctive treatment with trimetazidine decreases QT dispersion in patients with a first acute myocardial infarction.

PURPOSE: The metabolic management of ischemic heart disease represents a promising new therapeutic approach for acute coronary syndromes. Trimetazidine has been suggested to exert anti-ischemic properties on myocardium without affecting myocardial oxygen consumption or supply. The aim of this study was to investigate whether the administration of trimetazidine, as an adjunct to conventional treatment, decreases QT dispersion in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: The study was prospective, randomized, double-blind and included 55 out of 86 consecutive patients aged < or = 80 years, admitted with a first AMI. Excluded from the study subjects with atrial fibrillation or pacing-rhythm, bundle branch block, pericardial or valvular heart disease or cardiogenic shock. Also were excluded patients treated with inotropic and antiarrhythmic agents, except for beta blockers. Enrolled patients were randomized into 2 groups: Trimetazidine group (n=29) and control group (n = 26). All patients were treated conventionally and, in addition, trimetazidine group patients were received trimetazidine 20 mg orally every 8 hours started after randomization and continued throughout hospitalization. The QT and QTc (corrected QT) dispersion were measured manually on 3 and 7 post-AMI days. The mean values of QT and QTc dispersion were significantly lower in trimetazidine group on both days, compared to control group: Day 3, QTD = 52+/-24 ms vs 68+/-30 ms (p = 0.034), QTcD = 52+/-21 ms vs 75+/-34 ms (p = 0.004). Day 7, QTD = 39+/-17 ms vs 60+/-20 ms (p < 0.0001), QTcD 40+/-17 ms vs 62+/-20 ms (p < 0.0001). Between days 3 and 7 the mean values of QT (p = 0.003) and QTc dispersion (p = 0.002) were decreased significantly only in trimetazidine group. An analysis with respect to the use of thrombolysis revealed that trimetazidine sub-groups had lower QT and QTc dispersion mean values on day 7, both in patients treated (p < 0.05) and non-treated (p = 0.001) with thrombolysis. CONCLUSIONS: It is concluded that trimetazidine decreases QT and QTc dispersion after acute myocardial infarction. Further investigation is needed to evaluate the mechanism and the clinical implications of this effect.

Clinical characteristics and follow-up of patients with chest pain and normal coronary arteries.

The authors identified 160 men and women from all 3,700 patients with anginal pain between 1990 and 1994 who were subsequently found to have normal coronary arteries at diagnostic cardiac catheterization with follow-up to the present (mean follow-up 2.5 years). The group comprised 50 women and 110 men. Mean age was significantly greater in women (53.1 +/- 7.7 vs 47.2 +/- 9.2 years, p<0.001). Forty percent of the women but only 10% of the men had a positive exercise test. At follow-up, a larger proportion of patients continue to experience chest pain (95 patients, 59%) of whom 65 patients (41%) continue antianginal therapy. Furthermore one patient suffered a sudden cardiac death and two patients had a nonfatal myocardial infarction. Of patients referred with chest pain, women were more likely to have normal coronary arteries, compared with men. All patients have an excellent prognosis. A large proportion of women had a positive exercise test in the absence of coronary artery disease. On the other hand, morbidity remains high in these patients, despite the reassurance of a normal-appearing coronary arteriogram.

Segmental wall motion abnormalities alter vulnerability to ventricular ectopic beats associated with acute increases in aortic pressure in patients with underlying coronary artery disease.

OBJECTIVE: To evaluate whether patients with coronary artery disease are susceptible to pressure related ventricular arrhythmias, and if so to identify possible risk factors. DESIGN: Interventional study. METHODS: Metaraminol was given to 43 patients undergoing coronary arteriography for ischaemic heart disease to increase their aortic pressure, provided their systolic blood pressure was < 160 mm Hg and they were in sinus rhythm, without any ventricular ectopic activity (or with fewer than six ventricular ectopic beats a minute) during a five minute control period. RESULTS: During the metaraminol infusion, systolic aortic pressure rose from 131 (15) to 199 (12) mm Hg (mean (SD)). Ventricular ectopy appeared (or ventricular ectopic beats increased by > 100%) in 13/43 patients. Ventricular ectopy was not related to age, sex, presence of hypertension, history of myocardial infarction, use of beta blockers, positive exercise test, number of vessels diseased, or heart rate change during metaraminol infusion. There was a strong relation between the appearance of ventricular arrhythmia and segmental wall motion abnormalities: 1/19 (5.3%, 95% confidence interval 0.1% to 26.0%) without abnormality; 2/12 (16.7%, 2.1% to 48.4%) with hypokinesia; and 10/12 (83.3%, 51.6% to 97.1%) with akinesia or dyskinesia, chi 2 = 22.7, p < 0.001). Ejection fraction was also a significant but not independent risk factor. CONCLUSIONS: Patients with segmental wall motion abnormalities are predisposed to ventricular ectopic beats during an increase in systolic aortic pressure. This could be explained by associated electrophysiological inhomogeneity. The presence of mechanical inhomogeneity, as may occur in postinfarction akinesia or dyskinesia, may affect the aortic pressure above which ventricular arrhythmias appear.