Cardiology

Radiofrequency catheter ablation (RFA) is a cost-effective approach that has modified the treatment of patients with supraventricular tachycardia. In the Loire-Ardèche-Drôme-Isère-Puy-de-Dôme (LADIP) study, we compared RFA treatment with amiodarone therapy after the first episode of symptomatic atrial flutter. Results showed that RFA should be considered a first-line treatment, especially in elderly patients, because it has a better long-term success rate, the same risk of subsequent atrial fibrillation as amiodarone, and fewer secondary effects compared with amiodarone. Radiofrequency catheter ablation first-line therapy should be recommended in routine clinical practice, even when the atrial flutter is isolated without a previously documented atrial fibrillation episode.

Atrial flutter is an arrhythmia that occurs less commonly than atrial fibrillation and is often resistant to rate control and termination.

We compared the incidence of late clinical events after withdrawal of clopidogrel between subjects treated with drug-eluting stents (DES) and those treated with bare-metal stents. Death and myocardial infarction occurred more frequently among DES-treated subjects during the follow-up period. The results of this study indicate that there may be a penalty for the lower rate of restenosis and reinterventions after DES implantation, in particular, an increased rate of late stent thromboses.

The study by Handke et al focuses on one of the most controversial areas of interventional cardiology—the clinical downside of treatment with drug-eluting stents (DES).

A total of 114 patients with an intermediate pretest likelihood of coronary artery disease were evaluated with both multislice computed tomography (MSCT) and myocardial perfusion imaging (MPI). Results showed that in the majority of cases, a normal MSCT scan was associated with normal perfusion. However, only half of patients with significant stenoses showed abnormal perfusion. Accordingly, MPI and MSCT are intrinsically different techniques and appear to be complementary rather than overlapping as they provide information on atherosclerosis versus ischemia, respectively.

The study by Schuijf and Bax, which compares multislice computed tomography (CT) versus myocardial perfusion imaging, is very timely, as this new cardiac imaging modality has gained rapid acceptance by cardiologists for managing patients.

We conducted a meta-analysis of 13 randomized controlled trials involving 17 963 subjects to determine the effect of intensive statin therapy instituted within 14 days of hospitalization for acute coronary syndrome. Results showed that early, intensive statin therapy is safe and significantly decreases cardiovascular death and recurrent ischemia following acute coronary syndrome after 6 months of treatment.

There is now substantial evidence that treatment with statins improves clinical outcomes in patients with acute as well as chronic coronary heart disease, and in older1 as well as younger patients

We evaluated the effectiveness of the current American Diabetes Association guidelines for the detection of coronary artery disease (CAD) in asymptomatic patients with type 2 diabetes and assessed whether a more aggressive diagnostic strategy would permit detection of silent CAD at an earlier stage. The prevalence of myocardial perfusion defects and CAD in asymptomatic diabetic patients was high independent of risk factor profile, and an aggressive diagnostic approach in patients who would normally be excluded from screening permitted identification of CAD at an earlier stage, when coronary anatomy is more likely to respond to treatment.

Coronary artery disease (CAD) accounts for approximately 75% of deaths in patients with diabetes.1

A 67-year-old man with positive results on a stress myocardial perfusion test was found to have isolated anomalous origin of the left anterior descending coronary artery from a separate coronary ostium of the right sinus of Valsalva. This anomalous artery was not stenotic and coursed over the anterior free wall of the right ventricle, in front of the pulmonary artery. It did not appear to have an intra-arterial or intramyocardial course.

The case report by Gandhi and Rosenberg illustrates some of the concerns regarding coronary anomalies.

Diuretic use is associated with activation of neurohormones and disease progression in heart failure. Yet, diuretics are commonly prescribed, although little is known about their long-term effects. We performed a study based on propensity score matching, which indicated that in subjects with ambulatory, chronic, mild-to-moderate heart failure, diuretic use was associated with increased mortality and hospitalization. These findings call into question the wisdom of using long-term diuretic therapy in heart failure patients who are asymptomatic or minimally symptomatic.

Diuretic use has long been a mainstay in the management of symptomatic heart failure with pulmonary or systemic congestion, or both.

We investigated whether a program based on diffuse deployment of automated external defibrillators operated by trained volunteers and laypersons across the largest county in Italy would safely and effectively improve the current survival rate among patients with out-of-hospital cardiac arrest. Compared with historical control subjects, the new strategy resulted in a 3-fold increase in 1-year survival free of neurologic impairment.

Cardiac arrest (CA) is a leading cause of death in industrial countries, with approximately 350 000 fatal episodes each year in the United States alone.

We assessed preoperative cardiac physiology using echocardiography in patients undergoing cardiac surgery to identify predictors of postoperative atrial fibrillation. Subjects with enlarged left atrial volume had a 5-fold greater risk of postoperative atrial fibrillation, independent of age and other risk factors, than those without enlarged left atrial volume. Left atrial volume appears to be a powerful tool to stratify patients according to risk before surgery and to effectively target preventive therapy.

Atrial fibrillation that occurs after cardiac surgery remains a source of increased morbidity and prolonged length of hospital stay.

Diabetes and inflammation influence the development of atherosclerosis. We performed a study that showed the inflammatory markers high-sensitivity C-reactive protein and lipoprotein-associated phospholipase A2 were lowered with the use of fenofibrate, simvastatin, and combination therapy. The anti-inflammatory effects were most pronounced among patients with elevated baseline inflammatory markers. Combination therapy significantly altered lipid concentrations and exerted a greater positive effect on low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and triglycerides than monotherapy with either drug.

The principal finding of this study is that among patients with type II diabetes and mixed dyslipidemia, treatment with simvastatin, fenofibrate, or their combination was associated with reductions in inflammatory biomarkers high-sensitivity C-reactive protein (hsCRP) and lipoprotein-associated phospholipase A2 (Lp-PLA2).

In patients with lone paroxysmal atrial fibrillation (AF) and normal cardiac function, in the absence of hypertension, myocardial infarction, and cardiac insufficiency, perindopril (Aceon) or losartan (Cozaar) and low-dose amiodarone (Cordarone) therapy are more effective in preventing recurrence of AF than low-dose amiodarone alone. Adding losartan or perindopril to amiodarone therapy can inhibit left atrial enlargement.

Atrial fibrillation (AF) is the most common arrhythmia, accounting for approximately one third of all patient discharges with arrhythmia as the principal diagnosis and the greatest number of hospitalization days for arrhythmia each year.