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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Embolism may occur after cardioversion of atrial arrhythmias, especially atrial fibrillation, despite the apparent exclusion of preexisting atrial thrombus. This is related to the now well-known phenomenon of "atrial stunning" following either electrical or pharmacological cardioversion. It has also been suggested that "de novo" atrial thrombus formation after cardioversion could be responsible for the embolic event. We report a case of low-energy internal cardioversion of chronic atrial fibrillation in a patient with recurrent episodes of heart failure followed by a de novo left appendage thrombus formation. The patient, followed clinically and by repeated transesophageal echocardiograms, did not show any clinical sign of thromboembolism and the left appendage thrombus regressed completely, as demonstrated on the transesophageal echocardiogram.
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PMID:[Atrial thrombosis following the low-energy DC internal countershock of chronic AF: considerations of a clinical case]. 988 97

The sample included 91 inpatients with different clinical forms of ischemic heart disease (IHD) and modes of subjective perception of illness (subjective meaning of illness). Prichard's Reaction to Illness Questionnaire, Hospital Anxiety and Depressive Scale, Rotter's Internal-External Control Scale and Illness Locus of Control Scale (Bevz I.A.,1998) were used on day 14 after admission for qualification of the patient's subjective perception of illness. The following clinical predictors of hypernosognia (inadequately high subjective significance of illness) were revealed: 1) the onset of IHD in midlife (<65 years) with its subsequent fast progression including high incidence of recurrent coronary events and/or congestive heart failure, 2) "typical" and protracted angina pectoris, 3) cardiac arrhythmias accompanying persistent high heart rate (sinus tachycardia, chronic atrial fibrillation, frequent extrasystoles) and defying any self-care, and 4) severe heart failure. On the other hand clinical predictors of hyponosognosia (inadequately low subjective significance of illness) included 1) the onset of IHD in elderly individuals (>65 years) and its subsequent slow progression without recurrent coronary events and/or congestive heart failure, 2) the socalled "anginal syndrome" (lack of angina's coupling with psychical exertion, atypical pain location, inconstant efficiency of nitroglycerin) and silent myocardial ischemia, 3) the paroxysmal cardiac arrhythmias (infrequent extrasystoles, paroxysmal atrial fibrillation, supraventricular tachyarrhythmias) with normal or slow heart rate between the paroxysms and high efficiency of self-care, and 4) mild to moderate heart failure. The findings are discussed in terms of prediction of specific modes of subjective perception of illness and its practical implications for correction of patient's attitude to his/her disease, correction of non-compliance, optimization of therapeutical alliance and use of heart care resources.
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PMID:[Clinical features of ischemic heart disease and modes of subjective perception of illness]. 1066 82

BACKGROUND: Propafenone has been claimed to be effective in converting atrial fibrillation and flutter to sinus rhythm; however, controlled clinical trials have reported variable results, and data about the safety of propafenone in the setting of heart failure are lacking. The aim of the present study was to evaluate the efficacy and safety of intravenous propafenone in converting atrial fibrillation and flutter to sinus rhythm. METHODS: Sixty patients with acute (<72 h) or chronic atrial fibrillation or flutter were included in a randomized, placebo-controlled, conditional cross-over study. Twenty eight patients, of whom 12 were in New York Heart Association class III and IV, had heart failure. Patients received intravenous propafenone (2 mg/kg in 10 minutes) and placebo subsequently at 1 hour intervals if sinus rhythm was not achieved. The patients' rhythms were continuously monitored for 1 hour and a 12-lead electrocardiogram, a 1-minute continuous rhythm strip and vital signs were recorded at baseline and at 15, 30, 45, and 60 minutes after the administration of each drug. RESULTS: Twenty of teh 59 patients (34%) treated with propafenone converted to sinus rhythm, while only 4 of the 50 patients (8%) treated with placebo converted (P <.001). Propafenone was more effective in patients with acute (<72 h) atrial fibrillation (64.5%). The conversion rate with propafenone was not significantly different from placebo in patients with atrial flutter and chronic atrial fibrillation (>72 h). Propafenone significantly decreased (P <.005 vs placebo) mean ventricular rate in nonresponders with a baseline heart rate of more than 100 beats/min. No clinically significant adverse effect occurred. CONCLUSIONS: We conclude that intravenous propafenone treatment is effective for converting acute atrial fibrillation; however, it seems unlikely to be beneficial in atrial flutter and chronic atrial fibrillation. Propafenone decreases ventricular rate in nonresponders, and a single dose of propafenone is relatively safe even in moderate-to-severe heart failure.
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PMID:Intravenous Propafenone for Conversion of Atrial Fibrillation or Flutter to Sinus Rhythm: A Randomized, Placebo-controlled, Crossover Study. 1068 66

In patients with severe chronic heart failure, many deaths are sudden due to life-threatening ventricular arrhythmias. Supraventricular arrhythmias such as paroxysmal or chronic atrial fibrillation may also cause serious complications in those patients due to acute loss of atrial contraction, pump failure during rapid ventricular response and embolic events. Two therapeutic strategies are currently available for therapy and prevention of malignant ventricular arrhythmias and subsequent sudden arrhythmic death: antiarrhythmic drug therapy and implantable defibrillators. However, selection of the most beneficial strategy for the individual patient to reduce the risk of sudden death remains a major challenge in cardiology. Betablockers exert a favorable antiarrhythmic action without increasing proarrhythmia, thus betablockers may serve as a basic medication in patients at risk for sudden death. However, the general use of antiarrhythmic drug therapy for symptomatic ventricular arrhythmias is not recommended, as these drugs have been shown to increase mortality in patients with severe congestive heart failure due to proarrhythmic or negative inotropic effects (e.g. class Ia antiarrhythmics). Even class III antiarrhythmic drugs such as amiodarone, which has been studied sufficiently in patients with left ventricular dysfunction, is not effective enough for significant reduction of cardiac mortality in patients with symptomatic ventricular arrhythmias and depressed ventricular function (e.g. EMIAT, CAMIAT). But as a positive result of available studies, amiodarone does not increase mortality in those patients. Dofetilide has also not been shown to prolong life significantly by suppressing malignant ventricular arrhythmias (DIAMOND-Study). In patients with symptomatic ventricular arrhythmias or aborted sudden death, ICD therapy has been proven to be superior to antiarrhythmic drug therapy in cardiac mortality reduction as a secondary prevention strategy (e.g. AVID, CASH, CIDS). For primary prevention of sudden arrhythmic death in high risk patients, 2 studies (MADIT, MUSST) have already demonstrated favorable results, decreasing mortality by ICD therapy in selected patient populations with partly-reduced ventricular function and unsustained but inducible ventricular tachycardias. This topic is, however, undergoing further evaluation by ongoing trials (e.g. MADIT II, SCD-HeFT). From available data, antiarrhythmic drug therapy in high risk patients is not justified on a routine basis, whereas ICD therapy as a secondary and perhaps primary prevention strategy will significantly reduce cardiac mortality in patients with severe heart failure. Sotalol, a class III antiarrhythmic agent, has recently been shown to reduce ICD-shock delivery which indicates that concomitant drug therapy in patients with an ICD device already implanted may be beneficial in terms of reducing ICD discharges due to ventricular and supraventricular tachycardias. In patients with paroxysmal atrial fibrillation and congestive heart failure, restitution of sinus rhythm is the primary therapeutic goal which can be safely achieved by amiodarone and dofetilide (DIAMOND). In the latter, continuous monitoring of the patient is mandatory because of increased risk of torsade de pointes arrhythmias during the first days of drug administration. In patients with chronic atrial fibrillation rate control and anticoagulation with warfarin is the primary therapeutic option, which can be achieved with either drug treatment (Digoxin, betablockers, amiodarone) or by His bundle ablation with subsequent pacemaker insertion.
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PMID:[Antiarrhythmic therapy in patients with heart failure]. 1085 93

Cardiac arrhythmias are very common in the setting of heart failure, with atrial and ventricular arrhythmias often present in the same patient. The risk and the benefit of antiarrhythmic therapies are still a matter of debate. Class I antiarrhythmic drugs should be avoided in patients with heart failure, cardiac ischemia, or previous myocardial infarction. Beta-blocker agents reduce morbidity and decrease mortality in patients suffering from moderate to severe heart failure. Amiodarone may be beneficial in patients with advanced heart failure and increased resting heart rates. This class III drug may be effective to suppress episodes of atrial fibrillation but can also be beneficial in reducing ventricular response by slowing atrioventricular conduction during chronic atrial fibrillation. Implantable cardioverter-defibrillators (ICDs) markedly reduce sudden cardiac death in patients with ventricular tachycardia or ventricular fibrillation. In patients with advanced heart failure, however, the ICD may not markedly extend survival. Recently analyzed data from the Canadian Implantable Defibrillator Study (CIDS), Antiarrhythmics Versus Implantable Defibrillators (AVID) registry, Multicenter Unsustained Tachycardia Trial (MUSTT), and Multicenter Automatic Defibrillator Implantation Trial (MADIT) have consistently shown that it is the sickest patient who benefits the most from ICD therapy. Patients with markedly depressed ejection fraction (<30%), poor New York Heart Association functional class, and advanced age have been identified as those who really need ICD therapy. Studies of implantable cardioverter-defibrillators in patients with moderate to severe heart failure have been launched and will provide necessary answers to the question of whether a reduction in sudden death will translate into a reduction of all-cause mortality. For patients resuscitated from sustained ventricular tachycardia or ventricular fibrillation, an ICD or, in some cases, amiodarone should be considered. Catheter or surgical ablation can be considered for selected patients with ventricular tachycardia.
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PMID:Arrhythmias in Heart Failure. 1109 38

This is a synopsis of presentations made at the American College of Cardiology (ACC) in 2001 summarising recent research developments relating to heart failure. Clinical studies of particular interest to physicians with an interest in heart failure and its prevention are reviewed. The COPERNICUS trial lends further support to the use of the beta-blocker, carvedilol, in severe heart failure and the CAPRICORN trial to its use in patients with post-infarction left ventricular systolic dysfunction. The MIRACLE study reinforces the evidence from three smaller trials that cardiac resynchronisation therapy is an effective treatment for the relief of symptoms in patients with severe heart failure and cardiac dyssynchrony. The STAF trial casts further doubt on the wisdom of cardioversion as a routine strategy for the management of chronic atrial fibrillation. The RITZ-2 trial suggests that an intravenous, non-selective endothelin antagonist is effective in improving haemodynamics and symptoms and possibly in reducing morbidity in severe heart failure. Observational studies in heart failure suggest that a moderate excess of body fat and elevated blood cholesterol may be desirable in patients with heart failure, challenging the current non-evidenced-based vogue for cholesterol lowering therapy in heart failure. The RENAISSANCE and RECOVER outcome studies of etanercept, a tumour necrosis factor (TNF) receptor analogue that blocks the effect of TNF, were stopped because of lack of evidence of benefit shortly after the ACC.
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PMID:Clinical Trials Update: CAPRICORN, COPERNICUS, MIRACLE, STAF, RITZ-2, RECOVER and RENAISSANCE and cachexia and cholesterol in heart failure. Highlights of the Scientific Sessions of the American College of Cardiology, 2001. 1137 12

Abnormalities in impulse formation and conduction are common in the elderly. Changing technology has led to new pacemakers of enormous complexity and flexibility. Hemodynamic changes due to aging include a greater contribution of atrial contraction to ventricular filling. Dual-chamber pacing which maintains atrial transport, is associated with less incidence of chronic atrial fibrillation, stroke, heart failure, pacemaker syndrome, and death. Bipolar systems are free of inhibition due to pectoral myopotentials and cross talk in the case of dual-chamber pacing. Invasive electrophysiologic studies have very low risk of complications and can provide important information at the time of choosing the optimal pacing system for a specific patient. In the patient with stable atrial rhythm, pacing systems that maintain atrial transport are preferred over simple ventricular pacing.
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PMID:Pacemakers in the Elderly: Selection of Pacing Systems. 1141 4

Left ventricular hypertrophy (LVH) is supposed to be a useful marker of cardiovascular complications during the course of hypertension. Authors compared the presence of heart failure, left ventricular diastolic dysfunction and chronic atrial fibrillation in hypertensive patients with and without left ventricular hypertrophy defined by echocardiography. Hospital records of 192 hypertensives treated in our medical department during years 1996-1999 were analysed. Left ventricular hypertrophy was defined by echocardiography (Penn convention) as left ventricular mass index > 134 g/m2 in men and > 110 g/m2 in women. Presence of LVH was found in 128 patients (mean age 65.9 years), absence of LVH in 64 patients (mean age 64.8 years). Both groups of hypertensives were matched by demographic parameters, by the presence of hyperlipidemia, by smoking habits. Hypertensive patients with left ventricular hypertrophy were more often treated by ACE inhibitors. There were statistically significant more patients with heart failure, left ventricular diastolic dysfunction and chronic atrial fibrillation in LVH-positive patients than in LVH-negative once. There was also statistically significant lower ejection fraction (50.3 +/- 11.4% vs 56.5 +/- 7.4%) in LVH-positive patients than in LVH-negative once. Left ventricular hypertrophy in patients with hypertension brings usually a complicated course of the disease with a high contribution to the development of chronic heart failure.
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PMID:[Heart failure in hypertensive patients with left ventricular hypertrophy]. 1149 79

It is widely believed that physiologic pacing (defined as atrial or atrioventricular synchronous pacing) reduces cardiac morbidity and mortality and is associated with improved quality of life compared to ventricular pacing. In this review we present data from three large prospective trials (PASE, CTOPP, MOST) comparing physiologic pacing to ventricular pacing. The prospective trials report that physiologic pacing is associated with a reduced risk of developing chronic atrial fibrillation over time and improved quality of life in patients with sinus node disease compared to ventricular pacing. However, these trials failed to demonstrate that physiologic pacing reduces heart failure, thromboembolism, or cardiac death compared to ventricular pacing. Based on the available clinical trials, physiologic pacing is not indicated in patients with a short life expectancy. Physiologic pacing should be considered for younger patients (age < 75 years), patients likely to be pacemaker dependent, and patients for whom maintenance of sinus rhythm is desirable, i.e., patients with ventricular hypertrophy and diastolic dysfunction who are most likely to be severely symptomatic if AV synchrony is lost.
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PMID:[Pacing mode influence on morbidity and mortality]. 1175 87

A noteworthy shift from class I to class III antiarrhythmic agents for suppression of atrial fibrillation has occurred. Sotalol, amiodarone, and dofetilide have been evaluated for their ability to maintain sinus rhythm in patients with chronic atrial fibrillation. All of these agents are moderately effective; however, amiodarone appears to be most efficacious. Aside from their common class III actions, these agents have profoundly different pharmacologic, pharmacokinetic, safety, and drug interaction profiles that help guide drug selection. Amiodarone and dofetilide are safe in patients who have had a myocardial infarction and those with heart failure. The safety of commercially available d,l-sotalol in these patients is poorly understood. Torsades de pointes is the most serious adverse effect of sotalol and dofetilide, and risk increases with renal dysfunction. Amiodarone has minimal proarrhythmic risk but has numerous noncardiac toxicities that require frequent monitoring. Overall, an ideal antiarrhythmic agent does not exist, and drug selection should be highly individualized.
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PMID:A review of class III antiarrhythmic agents for atrial fibrillation: maintenance of normal sinus rhythm. 1176 3


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