American heart journal
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American heart journal · Jan 2001
Randomized Controlled Trial Comparative Study Clinical TrialLead- and device-related complications in the antiarrhythmics versus implantable defibrillators trial.
Implantation of transvenous implantable cardioverter defibrillators (ICDs) by use of a nonthoracotomy approach has become routine therapy for survivors of life-threatening tachyarrhythmias. The purpose of this study was to identify and prospectively characterize the frequency of lead- and ICD-related complications from the Antiarrhythmics versus Implantable Defibrillators (AVID) Trial. ⋯ These data suggest that cephalic vein access and pectoral generator site may result in fewer complications. The continued occurrence of lead fractures and the need for premature system revision supports the practice of close routine ICD system surveillance.
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American heart journal · Dec 2000
Randomized Controlled Trial Comparative Study Clinical TrialRate-control versus conversion strategy in postoperative atrial fibrillation: a prospective, randomized pilot study.
Atrial fibrillation remains a frequent complication after heart surgery. The optimal strategy to treat the condition has not been established. Several retrospective studies have suggested that a primary rate-control strategy may be equivalent to a strategy that restores sinus rhythm. ⋯ This pilot study shows little difference between a rate-control strategy and a strategy to restore sinus rhythm. Regardless of strategy, most patients will be in sinus rhythm after 2 months. A larger randomized, controlled study is needed to assess the impact of restoration of sinus rhythm on length of stay.
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American heart journal · Sep 2000
Randomized Controlled Trial Multicenter StudyPilsicainide for conversion and maintenance of sinus rhythm in chronic atrial fibrillation: a placebo-controlled, multicenter study.
Pilsicainide is a newly synthesized antiarrhythmic agent with class Ic properties. Various antiarrhythmic agents have been used to convert atrial fibrillation (AF) to sinus rhythm or decrease the rate of relapse of AF. ⋯ Pilsicainide is effective in restoring or maintaining sinus rhythm in patients with chronic AF lasting longer than an average duration of 22 months. No major adverse effects were observed.
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American heart journal · Sep 2000
Randomized Controlled TrialEffects of diltiazem pretreatment on direct-current cardioversion in patients with persistent atrial fibrillation: a single-blind, randomized, controlled study.
Electric conversion of atrial fibrillation is the most widely used and effective treatment for sinus rhythm restoration. However, it has a limited success rate and a high recurrence rate. ⋯ Although diltiazem seems to be as effective as amiodarone in reducing early atrial fibrillation recurrences, diltiazem is less effective in determining spontaneous or electric conversion, with a higher recurrence rate at 2 months. Diltiazem pretreatment could be considered as only a second choice treatment in those patients in whom amiodarone is contraindicated.
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American heart journal · Jul 2000
Randomized Controlled Trial Comparative Study Clinical TrialEsmolol versus diltiazem in the treatment of postoperative atrial fibrillation/atrial flutter after open heart surgery.
Supraventricular tachyarrhythmias are common after open heart surgery. Possible causative factors for these arrhythmias include operative trauma, atrial ischemia, electrolyte imbalances, pericardial irritation, and excess catecholamines. Two agents commonly used to control ventricular rate in atrial fibrillation or atrial flutter (AF/AFL) are beta-blockers and calcium channel blockers. ⋯ Although this is a small study, it suggests that esmolol is more effective in converting patients to normal sinus rhythm than diltiazem during the initial dosing period. No differences in conversion rates were observed between the two groups after 24 hours. Additional studies are needed to confirm whether esmolol is the initial drug of choice in patients with postoperative AF/AFL after coronary bypass surgery.