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

This article continues a series of reports updating recent research developments of particular interest to personnel involved in the treatment and management of patients with heart failure. This is a summary of selected presentations made at the American College of Cardiology 51st Annual Scientific Session held in Atlanta on 17-20 March 2002. Reports of the following clinical studies are included: LIFE, DANAMI 2, MADIT-2, MIRACLE-ICD, OVERTURE, OCTAVE, ENABLE 1 & 2, CHRISTMAS, AFFIRM, RACE, WIZARD, AZACS, REMATCH, BNP trial and HARDBALL.
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PMID:Clinical trials update: highlights of the scientific sessions of The American College of Cardiology 2002: LIFE, DANAMI 2, MADIT-2, MIRACLE-ICD, OVERTURE, OCTAVE, ENABLE 1 & 2, CHRISTMAS, AFFIRM, RACE, WIZARD, AZACS, REMATCH, BNP trial and HARDBALL. 1203 66

The association between atrial fibrillation and heart failure is well documented. Heart failure is one of the established predisposing conditions for the development of atrial fibrillation; conversely, heart failure is a common condition in patients with atrial fibrillation. In patients with heart failure the atrial electrophysiologic properties might be modified by hemodynamic overloading and neurohumoral activation. Atrial fibrillation promotes heart failure with multiple mechanisms including uncontrolled heart rate, loss of atrioventricular synchrony, irregularity in the ventricular rhythm, valvular regurgitation and neurohormonal effects. Treatment includes correction of neurohumoral activation, prevention of thromboembolism, maintenance of sinus rhythm, and pharmacologic and interventional control of ventricular rate. The results of recent trials (PIAF-Pharmacological Intervention in Atrial Fibrillation, RACE-RAte Control versus Electrical cardioversion for persistent atrial fibrillation, AFFIRM-Atrial Fibrillation Follow-up Investigation of Rhythm Management) suggest that a rate control strategy can be better than rhythm control, particularly in patients at high risk of relapse, like those with left ventricular dysfunction.
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PMID:[Atrial fibrillation and heart failure: cause or effect?]. 1240 57

The Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM study) is a randomized comparative evaluation of rate control and rhythm control, both combined with antithrombotic therapy, as therapeutic strategies for the treatment of atrial fibrillation (AF). This study differs from the earlier AFFIRM and RACE studies in that it has a composite primary end-point representing mortality and also physical/psychological disablement (total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure requiring intravenous administration of diuretics, and patient disablement). Patients' will to change the therapeutic strategy to the other is also considered as an end-point representing disablement under the assigned strategy. The secondary end-point includes quality of life scores and the efficacy and safety of drugs used in treating AF. The J-RHYTHM study emphasizes patient-reported experience and perception of AF-specific disablement, and the safety of antiarrhythmics available in Japan; it will follow 2600 patients treated at more than 150 sites in Japan for a 3-year period.
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PMID:Investigation of the optimal treatment strategy for atrial fibrillation in Japan. 1293 46

Atrial fibrillation is the most common sustained cardiac arrhythmia. Treatment strategies are focused on reducing symptoms and minimizing the risks of atrial fibrillation like stroke and heart failure. First choice therapy is the rhythm control strategy, with restoration of sinus rhythm. Drawback of this approach is the low success rate for maintenance of sinus rhythm. Outcome will improve with the use of antiarrhythmic drugs after electrical cardioversion, unfortunately exposing the patient to the risks of life threatening pro-arrhythmia. The second alternative, a rate control strategy, is easy to achieve but it is unknown whether this treatment strategy results in higher morbidity and mortality rates. RACE (RAte Control versus Electrical cardioversion for persistent atrial fibrillation) was a prospective randomized trial comparing both strategies. The primary end point was a composite of death from cardiovascular causes, heart failure, thromboembolic complications, bleeding, pacemaker implants and severe adverse effects of drugs. After a mean follow-up of 2.3 years, the primary end point occurred in 44 of the 256 rate control patients (17.2%) and 60 of the 266 rhythm control patients (22.6%). Other trials as the AFFIRM (Atrial Fibrillation Follow-up Investigation of Rhythm Management), PIAF (Pharmacological Intervention in Atrial Fibrillation) and STAF (Strategies of Treatment of Atrial Fibrillation) also found that rate control was not inferior to rhythm control in terms of morbidity, mortality and quality of life. These four randomized trials demonstrated that a rate control strategy is an acceptable alternative to rhythm control in patients with recurrent atrial fibrillation. For those with severely symptomatic atrial fibrillation, continued rhythm control is unavoidable. For these patients, safer and more effective methods of maintaining sinus rhythm are needed to reduce morbidity related to palpitations and atrial fibrillation-induced heart failure.Furthermore, the randomized studies showed that rhythm control therapy does not prevent stroke. It was observed from RACE that 21 of the 35 thromboembolic complications occurred under rhythm control, the majority while receiving inadequate anticoagulation therapy. Also in AFFIRM, with patients with one or more stroke risk factors, more strokes were present under rhythm control. Therefore, one of the main lesson learned from the randomized studies is that anticoagulation must be continued if stroke risk factors are present even if patients maintain sinus rhythm.
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PMID:The RACE study in perspective of randomized studies on management of persistent atrial fibrillation. 1461 33

The Atrial Fibrillation (AF) Follow-up Investigation of Rhythm Management (AFFIRM) and Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation Study (RACE) Trials evaluated strategies of rate control or rhythm control in atrial fibrillation. AFFIRM enrolled patients with recent onset AF, and at entry over half of all patients were in sinus rhythm. At any point in the trial, the achieved difference in cardiac rhythm was likely only about 30%. In RACE all patients were entered in AF, and at the end of the study, sinus rhythm was present in 10% vs 39%. The strategy of rate control was non-inferior to the rhythm control strategy in both trials, and permits consideration of rate control as primary therapy. However, the actual differences in rhythm were relatively small, and do not allow the conclusion that maintenance of sinus rhythm is inferior to non-maintenance. Current guidelines recommend that patients with paroxysmal AF receive warfarin if they have risk factors for stroke. This is supported by data from AFFIRM. Most strokes in AFFIRM occurred either during subtherapeutic INR, or after cessation of warfarin. Since more patients in the rhythm control arm of AFFIRM discontinued warfarin, it is possible that asymptomatic recurrences of paroxysmal AF fostered clot development and embolization. We cannot answer from the data available whether or not it is safe to discontinue anticoagulation if all episodes of AF are suppressed. Among the reasons that AF is associated with increased mortality may be that it encourages development of congestive heart failure or progressive left ventricular dysfunction. Congestive heart failure occurrence was monitored in both trials, and occurred at a rate of 2-5% without significant differences between rate and rhythm arms. In patients with heart failure at entry, a mortality trend in AFFIRM favored the rhythm control arm. The issue of survivorship and rhythm control in AF in congestive heart failure is undergoing further testing.
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PMID:AFFIRM and RACE trials: implications for the management of atrial fibrillation. 1507 Dec 55

Atrial fibrillation (AF) is the most common form of arrhythmia, carrying high social costs. It is usually first seen by general practitioners or in emergency departments. Despite the availability of consensus guidelines, considerable variations exist in treatment practice, especially outside specialised cardiological settings. Cardioversion to sinus rhythm aims to: (i) restore the atrial contribution to ventricular filling/output; (ii) regularise ventricular rate; and (iii) interrupt atrial remodelling. Cardioversion always requires careful assessment of potential proarrhythmic and thromboembolic risks, and this translates into the need to personalise treatment decisions. Among the many clinical variables that affect strategy selection, time from onset is crucial. In selected patients, pharmacological cardioversion of recent-onset AF can be a safely used, feasible and effective approach, even in internal medicine and emergency departments. In most cases of recent-onset AF, pharmacological cardioversion provides an important--and probably more cost effective--alternative to electrical cardioversion, which can then be employed as a second-line therapy for nonresponders. Class IC agents (flecainide or propafenone), which can be safely used in hospitalised patients with recent-onset AF without left ventricular dysfunction, can provide rapid conversion to sinus rhythm after either intravenous administration or oral loading. Although intravenous amiodarone requires longer conversion times, it is still the standard treatment for patients with heart failure. Ibutilide also provides good conversion rates and could be used for AF patients with left ventricular dysfunction (were it not for high costs). For long-lasting AF most pharmacological treatments have only limited efficacy and electrical cardioversion remains the gold standard in this setting. However, a widely used strategy involves pretreatment with amiodarone in the weeks before planned electrical cardioversion: this provides optimal prophylaxis and can sometimes even restore sinus rhythm. Dofetilide may also be capable of restoring sinus rhythm in up to 25-30% of patients and can be used in patients with heart failure. The potential risk of proarrhythmia increases the need for careful therapeutic decision making and management of pharmacological cardioversion. The results of recent trials (AFFIRM [Atrial Fibrillation Follow-up Investigation of Rhythm Management] and RACE [Rate Control versus Electrical Cardioversion for Persistent Atrial Fibrillation]) on rate versus rhythm control strategies in the long term have led to a generalised shift in interest towards rate control. Although carefully designed studies are required to better define the role of pharmacological rhythm control in specific AF settings, this alternative option remains a recommendable strategy for many patients, especially those in acute care.
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PMID:Pharmacological cardioversion of atrial fibrillation: current management and treatment options. 1556 47

Although anticoagulant treatment of atrial fibrillation is now well codified, the medical treatment of the fibrillation remains controversial. Two types of medication can be proposed: drugs to slow the rhythm (digitalis, betablockers and calcium inhibitors) and anti-arrhythmic mainly Class I or Class III drugs. Some doubt was raised in the 1990's about the pertinence of antiarrhythmic therapy and four recent trials (AFFIRM, RACE, PIAF and STAF) compared the two attitudes of "rhythm control" or "rate control" in atrial fibrillation. The four trials all showed that the results of these two options were equivalent with respect to the therapeutic objectives: reduction of mortality, thromboembolic or haemodynamic risk, and regression of symptoms and improvement of the quality of life. However, these trials have not closed the debate on these two therapeutic attitudes. In fact, analysis shows that the comparison was biased because anticoagulant treatment was inadequate and, though the treatment for rate control was appropriate, the antiarrhythmic treatment was far from being satisfactory and effective. Moreover, many patients in the "rhythm control" group were in atrial fibrillation whereas a certain number of patients in the "rate control" group were, in fact, in sinus rhythm throughout the study period. In addition, the comparison was incomplete because it did not include two other particularly common populations in clinical practice: multi-relapsing paroxysmal atrial fibrillation in healthy hearts and atrial fibrillation associated with severe left ventricular dysfunction, patients with cardiac failure. Until the results of trials currently under way (AF-CHF) become available, the authors discuss the use of drugs for rate control and antiarrhythmic therapy in everyday practice.
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PMID:[Pharmacological treatment of atrial fibrillation]. 1571 91

Angiotensin-converting enzyme 2 (ACE2), a newly identified member in the renin-angiotensin system (RAS), acts as a negative regulator of ACE. It is mainly expressed in cardiac blood vessels and the tubular epithelia of kidneys and abnormal expression has been implicated in diabetes, hypertension and heart failure. The mechanism and physiological function of this zinc metallopeptidase in mammals are not yet fully understood. Non-mammalian vertebrate models offer attractive and simple alternatives that could facilitate the exploration of ACE2 function. In this paper we report the in silico analysis of Ace2 genes from the Gallus (chicken), Xenopus (frog), Fugu and Tetraodon (pufferfish) genome assembly databases, and from the Danio (zebrafish) cDNA library. Exon ambiguities of Danio and Xenopus Ace2s were resolved by RT-PCR and 3'RACE. Analyses of the exon-intron structures, alignment, phylogeny and hydrophilicity plots, together with the conserved synteny among these vertebrates, support the orthologous relationship between mammalian and non-mammalian ACE2s. The putative promoters of Ace2 from human, Tetraodon and Xenopus tropicalis drove the expression of enhanced green fluorescent protein (EGFP) specifically in the heart tissue of transgenic Xenopus thus making it a suitable model for future functional genomic studies. Additionally, the search for conserved cis-elements resulted in the discovery of WGATAR motifs in all the putative Ace2 promoters from 7 different animals, suggesting a possible role of GATA family transcriptional factors in regulating the expression of Ace2.
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PMID:ACE2 orthologues in non-mammalian vertebrates (Danio, Gallus, Fugu, Tetraodon and Xenopus). 1678 Oct 89

Rhythm control or rate control are the 2 therapeutic strategies for atrial fibrillation (AF) management. Despite strong physiological and epidemiological data to support a rhythm control strategy, the results of the prospective studies, especially AFFIRM and RACE trials, did not demonstrate any superiority of a rhythm control versus a rate control strategy. The AF-CHF trial conducted in heart failure patients led to the same conclusions. In clinical practice, the therapeutic management is only driven by the patient symptoms. For rhythm control, antiarrhythmic drugs are still the first step before considering, in selected patients, ablative techniques. Treatment algorithms proposed in 2006 by the European society of cardiology are the references for patient management, treatment being individually optimized.
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PMID:[Rate control or rhythm control]. 2010 77

Atrial fibrillation (AF) is the most common sustained arrhythmia in general population. AF in humans was first described in 1903. Gradually, it has been well appreciated that AF is notjust an acceptable alternative for normal rhythm but rather a serious threat, related to increased mortality and cardiovascular morbidity. AF can precipitate or worsen pre-existing heart failure, may cause the development of tachycardiomyopathy and is an independent risk factor for thromboembolic events, most frequently stroke. It has long been believed that rhythm control is the best therapy for AF. Nowadays there is a clear scientific proof that rhythm control offers no benefit over frequency control, at least for older patients, even with advanced left ventricular dysfunction. However, optimal treatment for younger, highly symptomatic, otherwise healthy AF patients has not been designed. Available antiarrhythmics have considerable proarrhythmic potential or organ toxicity, and new safer drugs are under investigation. Nonpharmacological approaches, namely RF-catheter ablation, are rapidly developing. Prevention of thromboembolism is imperative, and new safer oral anticoagulants have been intensively investigated. Recent randomized studies (PIAF, RACE, STAF, AFFIRM, HOT-CAFE) did not solve the issue of optimal arrhythmia treatment, but they emphasized the prevention of thromboembolism based on risk factors, and not on AF type, mainly because asymptomatic episodes of AF may not be clinically recognised.
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PMID:[Hundred years of atrial fibrillation: current knowledge and perspectives]. 2042 19


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