Cardiovascular therapeutics
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Review Meta Analysis
Surgical Maze procedure as a treatment for atrial fibrillation: a meta-analysis of randomized controlled trials.
Surgical or modified Maze procedures have been promoted to treat atrial fibrillation (AF); however, few randomized controlled clinical trials (RCTs) examine their outcomes. The purpose of this meta-analysis is to compare the efficacy of surgical Maze procedures performed concomitantly with referral cardiac surgery versus pharmacologic therapy for the treatment of AF. We searched MEDLINE, Cochrane database, FDA web-portal, and clinicaltrials.gov for all RCTs comparing surgical Maze procedures with medical therapy for sinus rhythm maintenance. ⋯ Among the two studies that fully reported AAD use, there was no evidence of improved survival free from AF and AAD therapy (OR 1.78, 95% CI 0.73-4.34). Among patients with valvular AF, surgical Maze procedures are associated with a decrease in AF one year postprocedure without significant increase in mean length of hospital stay, perioperative complications, operative, or all-cause mortality. Large RCTs defining rates of freedom from AF without AADs postprocedure, are still needed to evaluate outcomes and determine the appropriate role for surgical Maze procedures in the management of AF.
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Cardiovascular implantable electronic device (CIED) implantation indications have greatly increased over the past decade, with use of pacemakers and implantable cardiac defibrillators now growing more common even in athletes. Management of CIEDs in this subgroup is of greater complexity due to augmented physical stressors, a longer exposure time to system components in a younger population, and less common, highly clinically variable underlying cardiac pathologies. We will review management issues specific to CIED therapy, sudden cardiac death, and consensus recommendations for physical activity.
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Patients with structural heart disease and ventricular tachycardia (VT) can be difficult to manage clinically. Many treatment options are available, but no single approach can be applied to every patient. This review aims to discuss the current options available for the management of this population. ⋯ The development of catheter ablation over the past few decades has greatly aided the ability to control VT in these patients. The approach to patients with VT and structural heart disease is multifaceted. Often, a combination of therapeutic techniques is required to obtain the best result.