Background -Ventricular tachyarrhythmias long enough to cause implantable cardioverter defibrillator(ICD) shocks are generally thought to progress to cardiac arrest. In previous ICD trials, shocks have been considered...Background -Ventricular tachyarrhythmias long enough to cause implantable cardioverter defibrillator(ICD) shocks are generally thought to progress to cardiac arrest. In previous ICD trials, shocks have been considered an appropriate surrogate for sudden cardiac death(SCD) because the number of shocks has been thought to be equivalent to the mortality excess in patients without ICDs. The practice of equating ICD shocks with mortality is controversial and has not been validated critically. Methods and Results -The Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation(DEFINITE) trial was a prospective, randomized, multicenter trial of ICD therapy in 458 patients with nonischemic cardiomyopathy. Patients were randomized to receive standard medical therapy(STD) or STD plus an ICD. Shock electrograms were reviewed, and the cause of death was evaluated by a separate blinded events committee. There were 15 SCD or cardiac arrests in the STD group and only 3 in the ICD arm. In contrast, of the 229 patients randomized to an ICD, 33 received 70 appropriate ICD shocks. Patients in the ICD arm were more likely to have an arrhythmic event(ICD shock plus SCD) than patients in the STD arm(hazard ratio 2.12, 95%CI 1.153 to 3.893, P=0.013). The number of arrhythmic events when one includes syncope as a potential arrhythmic event was similar in both groups(hazard ratio 1.20, 95%CI 0.774 to 1.865, P=0.414). Approximately the same number of total events was noted in each arm when we compared syncope plus SCD/cardiac arrest in the STD arm with SCD plus ICD shocks plus syncope in the ICD arm. Conclusions -Appropriate ICD shocks occur more frequently than SCD in patients with nonischemic cardiomyopathy. This suggests that episodes of nonsustained ventricular tachycardia frequently terminate spontaneously in such patients.展开更多
BACKGROUND: Implantable cardioverter-defibrillator(ICD)therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in p...BACKGROUND: Implantable cardioverter-defibrillator(ICD)therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in patients early after myocardial infarction is unknown. METHODS: We conducted the Defibrillator in Acute Myocardial Infarction Trial, a randomized, open-label comparison of ICD therapy(in 332 patients)and no ICD therapy(in 342 patients)6 to 40 days after a myocardial infarction. We enrolled patients who had reduced left ventricular function(left ventricular ejection fraction, 0.35 or less)and impaired cardiac autonomic function(manifested as depressed heart-rate variability or an elevated average 24-hour heart rate on Holter monitoring). The primary outcome was mortality from any cause. Death from arrhythmia was a predefined secondary outcome. RESULTS: During a mean(±SD)follow-up period of 30±13 months, there was no difference in overall mortality between the two treatment groups: of the 120 patients who died, 62 were in the ICD group and 58 in the control group(hazard ratio for death in the ICD group, 1.08; 95 percent confidence interval, 0.76 to 1.55; P=0.66). There were 12 deaths due to arrhythmia in the ICD group, as compared with 29 in the control group(hazard ratio in the ICD group, 0.42; 95 percent confidence interval, 0.22 to 0.83; P=0.009). In contrast, there were 50 deaths from nonarrhythmic causes in the ICD group and 29 in the control group(hazard ratio in the ICD group, 1.75; 95 percent confidence interval, 1.11 to 2.76; P=0.02). CONCLUSIONS: Prophylactic ICD therapy does not reduce overall mortality in high-risk patients who have recently had a myocardial infarction. Although ICD therapy was associated with a reduction in the rate of death due to arrhythmia, that was offset by an increase in the rate of death from nonarrhythmic causes.展开更多
Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardiov...Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardioversion is necessary to prevent formation of new thrombus during atrial stunning period. We aimed to evaluate the efficacy and safety to TEE guided cardioversion with low molecular weight heparin(LMWH)in patients with atrial fibrillation. Methods: We followed up 208 patients with persistent AF(mean age: 65.5±10.2 years) who were attempted TEE guided cardioversion. LMWH were used as an anticoagulant and warfarin therapy was continued. Results: Cardioversion were performed in 183 patients. Sinus rhythm restored in 144 patients(78.7%). Mean follow up duration was 155 days. No cardiac death occurred. In the early follow up period(within 30 day) one thromboembolic event(0.54%) occurred in a patient who was cardioverted. Two patients who had not been cardioverted because of left atrial thrombus presented embolic stroke, one in early and another in late followup period. All embolic complications occurred in patients who had been taking warfarin and whose INR level was subtherapeutic at the time of stroke. Sinus rhythm was maintained in 64%and total hemorrhagic complications occurred in 4.8%of the patients in long-term follow-up. Conclusion: TEE guided cardioversion with a short-term anticoagulation protocol using low molecular weight heparin is a safe and effective method in restoring and maintaining sinus rhythm and enables us to make earlier cardioversion in atrial fibrillation.展开更多
文摘背景：人们认为，鱼体内的长链多元不饱和脂肪酸（ω-3PUFAs）可减少心律失常的发生，从而降低猝死的风险。
目的：比较鱼油保健品及安慰剂对室性快速性心律失常及死亡的影响。
设计、地点及患者：ω-3脂肪酸与室性心律失常关系研究”（study on Omega-3 Fatty acids and ventricular Arrhythmia，SOFA）是在欧洲26家心脏诊所中开展的一项随机、平行、安慰剂对照、双盲试验。
文摘Background -Ventricular tachyarrhythmias long enough to cause implantable cardioverter defibrillator(ICD) shocks are generally thought to progress to cardiac arrest. In previous ICD trials, shocks have been considered an appropriate surrogate for sudden cardiac death(SCD) because the number of shocks has been thought to be equivalent to the mortality excess in patients without ICDs. The practice of equating ICD shocks with mortality is controversial and has not been validated critically. Methods and Results -The Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation(DEFINITE) trial was a prospective, randomized, multicenter trial of ICD therapy in 458 patients with nonischemic cardiomyopathy. Patients were randomized to receive standard medical therapy(STD) or STD plus an ICD. Shock electrograms were reviewed, and the cause of death was evaluated by a separate blinded events committee. There were 15 SCD or cardiac arrests in the STD group and only 3 in the ICD arm. In contrast, of the 229 patients randomized to an ICD, 33 received 70 appropriate ICD shocks. Patients in the ICD arm were more likely to have an arrhythmic event(ICD shock plus SCD) than patients in the STD arm(hazard ratio 2.12, 95%CI 1.153 to 3.893, P=0.013). The number of arrhythmic events when one includes syncope as a potential arrhythmic event was similar in both groups(hazard ratio 1.20, 95%CI 0.774 to 1.865, P=0.414). Approximately the same number of total events was noted in each arm when we compared syncope plus SCD/cardiac arrest in the STD arm with SCD plus ICD shocks plus syncope in the ICD arm. Conclusions -Appropriate ICD shocks occur more frequently than SCD in patients with nonischemic cardiomyopathy. This suggests that episodes of nonsustained ventricular tachycardia frequently terminate spontaneously in such patients.
文摘BACKGROUND: Implantable cardioverter-defibrillator(ICD)therapy has been shown to improve survival in patients with various heart conditions who are at high risk for ventricular arrhythmias. Whether benefit occurs in patients early after myocardial infarction is unknown. METHODS: We conducted the Defibrillator in Acute Myocardial Infarction Trial, a randomized, open-label comparison of ICD therapy(in 332 patients)and no ICD therapy(in 342 patients)6 to 40 days after a myocardial infarction. We enrolled patients who had reduced left ventricular function(left ventricular ejection fraction, 0.35 or less)and impaired cardiac autonomic function(manifested as depressed heart-rate variability or an elevated average 24-hour heart rate on Holter monitoring). The primary outcome was mortality from any cause. Death from arrhythmia was a predefined secondary outcome. RESULTS: During a mean(±SD)follow-up period of 30±13 months, there was no difference in overall mortality between the two treatment groups: of the 120 patients who died, 62 were in the ICD group and 58 in the control group(hazard ratio for death in the ICD group, 1.08; 95 percent confidence interval, 0.76 to 1.55; P=0.66). There were 12 deaths due to arrhythmia in the ICD group, as compared with 29 in the control group(hazard ratio in the ICD group, 0.42; 95 percent confidence interval, 0.22 to 0.83; P=0.009). In contrast, there were 50 deaths from nonarrhythmic causes in the ICD group and 29 in the control group(hazard ratio in the ICD group, 1.75; 95 percent confidence interval, 1.11 to 2.76; P=0.02). CONCLUSIONS: Prophylactic ICD therapy does not reduce overall mortality in high-risk patients who have recently had a myocardial infarction. Although ICD therapy was associated with a reduction in the rate of death due to arrhythmia, that was offset by an increase in the rate of death from nonarrhythmic causes.
文摘Background: Transesophageal echocardiography(TEE) gui-ded cardioversion to restoration of sinus rhythm is a therapeutic option in patients with atrial fibrillation(AF). Anticoagulation at the time of and after cardioversion is necessary to prevent formation of new thrombus during atrial stunning period. We aimed to evaluate the efficacy and safety to TEE guided cardioversion with low molecular weight heparin(LMWH)in patients with atrial fibrillation. Methods: We followed up 208 patients with persistent AF(mean age: 65.5±10.2 years) who were attempted TEE guided cardioversion. LMWH were used as an anticoagulant and warfarin therapy was continued. Results: Cardioversion were performed in 183 patients. Sinus rhythm restored in 144 patients(78.7%). Mean follow up duration was 155 days. No cardiac death occurred. In the early follow up period(within 30 day) one thromboembolic event(0.54%) occurred in a patient who was cardioverted. Two patients who had not been cardioverted because of left atrial thrombus presented embolic stroke, one in early and another in late followup period. All embolic complications occurred in patients who had been taking warfarin and whose INR level was subtherapeutic at the time of stroke. Sinus rhythm was maintained in 64%and total hemorrhagic complications occurred in 4.8%of the patients in long-term follow-up. Conclusion: TEE guided cardioversion with a short-term anticoagulation protocol using low molecular weight heparin is a safe and effective method in restoring and maintaining sinus rhythm and enables us to make earlier cardioversion in atrial fibrillation.
