Pacing and clinical electrophysiology : PACE
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Pacing Clin Electrophysiol · Jan 2013
Review Meta AnalysisPharmacologic rate versus rhythm-control strategies in atrial fibrillation: an updated comprehensive review and meta-analysis.
In patients with atrial fibrillation (AF), ventricular rate control with medications has been found to be noninferior in preventing clinical events, compared to a strategy converting patients to sinus rhythm and maintaining it with medications. Guidelines have accepted rate control as an acceptable therapeutic option. Most of the prior studies excluded patients without significant left ventricular dysfunction, or permanent AF. ⋯ This systematic review suggests no difference in clinical outcomes with a rate or rhythm-control strategy with AF. However, rehospitalization rates appear to be lower with pharmacological rate control for all ages, while finding support for rhythm control in younger patients.
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Pacing Clin Electrophysiol · Jan 2013
Clinical TrialIvabradine in the treatment of inappropriate sinus tachycardia in patients after successful radiofrequency catheter ablation of atrioventricular node slow pathway.
Inappropriate sinus tachycardia (IST) occurs relatively common after catheter ablation of slow pathway in patients with atrioventricular nodal reentrant tachycardia. The treatment of IST symptoms using β-blockers or calcium channel-blockers are often noneffective or not well tolerated. Ivabradine is a new heart rate (HR)-decreasing agent inhibiting sinus node If current. The purpose of the study was to evaluate the efficacy and safety of ivabradine in patients with persistent and β-blocker-resistant IST after successful radiofrequency (RF) ablation of atrioventricular node slow pathway. ⋯ Ivabradine is an effective treatment option to reduce HR and symptoms in patients with IST after RF ablation of atrioventricular node slow pathway. The therapy with ivabradine is well tolerated even with maximum daily dose.
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Pacing Clin Electrophysiol · Jan 2013
Controlled Clinical TrialTpeak - Tend and Tpeak - Tend /QT ratio as markers of ventricular arrhythmia risk in cardiac resynchronization therapy patients.
Cardiac resynchronization therapy (CRT) increases transmural dispersion of repolarization (TDR) and can be pro-arrhythmic. However, overall arrhythmia risk was not increased in large-scale CRT clinical trials. Increased TDR as measured by T(peak ) -T(end) (TpTe) was associated with arrhythmia risk in CRT in a single-center study. This study investigates whether QT interval, TpTe, and TpTe/QT ratio are associated with ventricular arrhythmias in patients with CRT-defibrillator (CRT-D). ⋯ Increased TpTe and increased TpTe/QT ratio are associated with increased incidence of ventricular arrhythmias in CRT-D. The utility of TpTe interval and TpTe/QT ratio as potentially modifiable risk factors for ventricular arrhythmias in CRT requires further study.