1,721,244 research outputs found
ROLE OF THE AUTOMATIC IMPLANTABLE CARDIOVERTER DEFIBRILLATOR IN THE PREVENTION OF SUDDEN CARDIAC DEATH
No full textN/
[Idiopathic atrial fibrillation: clinical and therapeutic problems]. FT La fibrillazione atriale idiopatica: problematiche cliniche e terapeutiche.
No full textAtrial fibrillation (AF) is defined as idiopathic when no one heart disease can be documented by clinical examination or by laboratory investigations. Epidemiological studies have shown that almost one third of all the cases of AF are idiopathic and that their incidence increases with age. Idiopathic AF may have different clinical manifestations: the paroxysmal form, characterised by long-lasting episodes, the transient recurrent form, characterised by frequent self-terminating episodes, or, less commonly, the chronic form. According to the literature, the risk of thromboembolic complications in idiopathic AF is not elevated and certainly lower than in AF associated with heart disease. By a clinical evaluation patients in whom an electrical cardioversion is necessary for reestablishing the sinus rhythm can be identified, considering that definite contraindications to electrical cardioversion exist. For prophylaxis of recurrences of AF the classical treatment with class 1A antiarrhythmic drugs (disopyramide or quinidine) is not very effective and not well tolerated; recently class 1C antiarrhythmic drugs have been employed with better results. In patients without heart failure their employment appears sufficiently safe. Amiodarone is certainly very effective but considering the serious side effects, its use must be limited to selected cases. Moreover non-pharmacological treatments (catheter ablation and surgery) have been developed recently for selected cases of AF refractory to antiarrhythmic drugs
Propafenone in the treatment of cardiac arrhythmias. A risk-benefit appraisal
No full textPropafenone is a potent antiarrhythmic agent effective in either supraventricular or ventricular tachyarrhythmias. For proper utilisation, some important pharmacological aspects must be considered, such as nonlinear pharmacokinetics, inability in some patients (poor debrisoquine metabolisers) to oxidise the drug in the liver, existence of at least one active metabolite (5-hydroxy-propafenone) and ability to exert a slight beta-blocking activity. Like all the other antiarrhythmic drugs, propafenone may be associated with adverse effects and may exert proarrhythmic effects. For this reason, its usage must be based on a careful analysis of the risk-benefit ratio, by considering the patient's profile as well as the characteristics of the arrhythmia and its prognostic significance. Propafenone appears to be very effective, and has a favourable risk-benefit profile in the treatment of all supra-ventricular arrhythmias. Particularly, it is effective in converting atrial fibrillation to sinus rhythm and in preventing atrial fibrillation recurrences, and is very effective in the pharmacological control of the arrhythmias of the Wolff-Parkinson-White syndrome. Propafenone is also effective in suppressing ventricular premature complexes and nonsustained ventricular tachycardias. However, because of potential proarrhythmic effects, its use in these arrhythmias must be considered after a careful analysis of the risk-benefit profile, which could be favourable in some patients, but less favourable in others (e.g. patients with coronary artery disease and ventricular dysfunction). In malignant ventricular arrhythmias, further studies are needed to define the limitations of antiarrhythmic drugs in comparison with non-pharmacological treatments, mainly cardioverter/defibrillators. At present, like the other class I antiarrhythmic agents, propafenone does not seem to be a first choice prophylactic agent for malignant ventricular arrhythmias, although more data from controlled studies are needed
Intravenous and oral propafenone: Pharmacokinetic-pharmacodynamic relationships and clinical implications
No full textN/
Letter by Ciliberti and Capucci regarding article, "medical therapy for secondary prevention and long-term outcome in patients with myocardial infarction with nonobstructive coronary artery disease"
No full textComment on: Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. [Circulation. 2017
DRUGS, SURGERY, CARDIOVERTER DEFIBRILLATOR - A DECISION BASED ON THE CLINICAL PROBLEM
No full textThese three therapeutic options are the basis of sudden cardiac death prevention: antiarrhythmic drugs, surgery, and automatic implantable cardioverter defibrillator. Each of these treatments has specific favorable and unfavorable indications. Antiarrhythmic drugs are mainly limited by the low therapeutic profile, proarrhythmic effects, complex pharmacokinetics and pharmacodynamics, possible negative inotropic effects, and the possible change of the organic substratum. Arrhythmia surgery may be limited by the need of a highly trained center, by a relatively high perioperative mortality (up to 15%), and by limited electrophysiological and clinical indications. The implantable cardioverter defibrillator is an expensive tool with a theoretically wide range of clinical indications, with already proven efficacy in converting ventricular fibrillation to sinus rhythm but with unproven efficacy on prolonging survival because of a lack of controlled trials (which, we must admit, is also true for drugs and surgery). The results of the ongoing multicenter trials on this item will clarify this clinical point. The choice among these different therapeutic options is mainly based on hemodynamic status (ejection fraction), feasibility of a surgical treatment, and the electrophysiological characteristics of the ventricular arrhythmia
- …
