The American journal of cardiology
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Randomized Controlled Trial
Comparison of Direct Current Synchronized Cardioversion to Ibutilide-Guided Catheter Ablation for Long-Term Sinus Rhythm Maintenance After Isolated Pulmonary Vein Isolation of Persistent Atrial Fibrillation.
Use of the antiarrhythmic ibutilide after isolated pulmonary vein isolation (PVI) might distinguish atrial remodeling severity and cases requiring further substrate modification, thereby improving efficacy of persistent atrial fibrillation (AF) treatment. Ninety-six consecutive patients with persistent AF were randomized after PVI to either direct current synchronized cardioversion (DCC group, n = 48) or 1 mg of intravenous ibutilide (ibutilide group, n = 48) followed by no further intervention if AF converted to sinus rhythm (SR) within 30 minutes (ibutilide conversion subgroup) or by complex fractionated atrial electrogram (CFAE) ablation until SR recovery or complete CFAE elimination (ibutilide nonconversion subgroup). ⋯ Among ibutilide conversion and nonconversion subgroups and DCC group, procedure, ablation, and x-ray exposure times differed significantly, as did 12-month SR maintenance rate before (81% vs 70% vs 56%; p = 0.043) or after reablation (86% vs 81% vs 60%; p = 0.042). In conclusion, in persistent AF treatment, ibutilide-guided ablation after PVI yields higher 1-year SR maintenance rate than PVI only.
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Bicuspid aortic valve (BAV) disease has a male predominance of approximately 3:1 and shows diverse presentations about aortic valve dysfunction. This study aimed to find independent determinants for significant aortic stenosis (AS) or significant aortic regurgitation (AR) in adults with BAV. We retrospectively investigated the medical records of 1,073 subjects (773 men, mean age 55 ± 14 years) who were first diagnosed with BAV disease by transthoracic echocardiography. ⋯ In multivariate logistic regression analysis, women, older age, and type 0 or type 3 BAV were associated with significant AS. In contrast, men, hypertension, and chronic kidney disease were correlated with significant AR. Significant valve dysfunction in adults with first diagnosed BAV was closely associated with age, gender, and BAV morphology.
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Randomized Controlled Trial Multicenter Study
Gender Differences in the Risk of Adverse Outcomes in Patients With Atrial Fibrillation and Heart Failure With Preserved Ejection Fraction.
Atrial fibrillation (AF) is associated with an increased risk for adverse events in patients with heart failure with preserved ejection fraction (HFpEF), but it is currently unknown if gender differences in these outcomes exist. To explore this hypothesis, we examined gender differences in the associations of AF with adverse outcomes in 3,385 (mean age 69 ± 9.6 years, 49% male, 89% white) patients with HFpEF from the Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial. Baseline AF cases were identified by self-reported history, medical record review, and baseline electrocardiogram data. ⋯ The association between AF and hospitalization was stronger in women (HR 1.63, 95% CI 1.40 to 1.91) than men (HR 1.37, 95% CI 1.18 to 1.58; p-interaction = 0.032). Although significant interactions were not observed for the other outcomes, we appreciated that the risk estimates were higher for women compared with men. In conclusion, AF increases the risk for adverse cardiovascular outcomes in patients with HFpEF, and the presence of this arrhythmia in women possibly is associated with a greater risk for adverse events than men.
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Review Meta Analysis
Meta-Analysis of the Relative Efficacy and Safety of Oral P2Y12 Inhibitors in Patients With Acute Coronary Syndrome.
A cornerstone of medical therapy for patients with acute coronary syndrome (ACS) is dual antiplatelet therapy, which includes aspirin and a P2Y12 inhibitor. Randomized controlled trials (RCTs) have shown that prasugrel and ticagrelor are superior to clopidogrel, but none directly compared these 3 commonly used oral P2Y12 inhibitors for safety and efficacy. Therefore, we performed a Bayesian network meta-analysis of RCTs to compare the efficacies and safeties of 3 commonly used oral P2Y12 inhibitors in patients with ACS. ⋯ In treatment ranking, ticagrelor was the most efficacious, and prasugrel was the least safe. In conclusion, this meta-analysis shows that in patients with ACS, adding P2Y12 inhibitors to aspirin and other standard treatments reduces ischemic events and all-cause mortality. Among the commonly used oral P2Y12 inhibitors, ticagrelor has the best net efficacy and safety profile.