Recainam, A potent new antiarrhythmic agent: Effects on complex ventricular arrhythmias

The antiarrhythmic efficacy and safety of intravenous recainam, a newly synthesized compound displaying potent class I antiarrhythmic activity, were tested in 10 hospitalized patients with frequent (>30/h) complex ventricular ectopic beats. There were seven men and three women of average age 57 years (range 21 to 74); five had ischemic heart disease, three had cardiomyopathy and two had valvular heart disease. Recainam was given as a 3.0 mg/kg per 40 min loading infusion followed by a 0.9 mg/kg per h maintenance infusion over a 24 hour observation period. Arrhythmia response was assessed both in the short term (comparing 2 hours before and 1 hour after drug loading) and in the long term (comparing 48 hours before drug loading and 23 hours of maintenance infusion).The median frequency of total premature ventricular complexes decreased in the short term by 99.6% (from 392.5 to 1.5/h, p < 0.005) and in the long term by 99.7% (from 435 to 1.3/h, p < 0.01). Repetitive beats were suppressed by a median of 100% both in the short term (p < 0.006) and during 24 hour infusion (from 80.9 to 0/h, p < 0.003). More than 90% suppression of repetitive beats occurred in all 10 patients (100%) and more than 90% suppression of total arrhythmias occurred in 9 patients (90%) during the maintenance period. Electrocardiographic PR and QRS intervals increased by 19% (p < 0.001) and 24% (p < 0.003), respectively, during therapy, but the JTc interval decreased (p < 0.001). Plasma recainam concentrations averaged 5.2 ± 0.9 μg/ml after loading and 3.0 ± 0.5 μg/ml during maintenance therapy. No adverse symptoms occurred.In summary, recainam is a promising, highly efficacious and well tolerated agent when administered intravenously for short-term and maintenance suppression of complex ventricular arrhythmias. The efficacy of oral and intravenous recainam for arrhythmia management deserves further evaluation

Serum markers of deranged myocardial collagen turnover: their relation to malignant ventricular arrhythmias in cardioverter-defibrillator recipients with heart failure

BACKGROUND: Pathologic collagen remodeling has been involved in the occurrence of ventricular arrhythmias and sudden cardiac death in heart failure. The aim of the study was to investigate the relationship between malignant ventricular arrhythmias and cardiac collagen turnover indexes, expressing specific types of derangement in collagen physiology, in stable patients with an implantable cardioverter-defibrillator (ICD). METHODS: Seventy-four patients with an ICD and heart failure were studied. They had coronary artery disease (n = 42) or dilated cardiomyopathy, New York Heart Association classes I and II, and left ventricular ejection fraction 29% +/- 1%. An ICD had been implanted for secondary (n = 36) or primary prevention of sudden cardiac death. We assessed (1) markers of collagen types I and III synthesis and their ratio: procollagen type I carboxyterminal peptide (PICP), procollagen type III aminoterminal peptide (PIIINP), and PICP/PIIINP; (2) markers of collagen degradation, degradation inhibition, and their ratio: matrix metalloproteinase 9 (MMP-9), tissue inhibitor of matrix metalloproteinase (TIMP) 1 (TIMP-1), and MMP-9/TIMP-1. Patients were prospectively followed up for 1 year. The number of episodes necessitating appropriate interventions for ventricular tachyarrhythmias (&gt;170 beat/min) was related to the assessed parameters. RESULTS: Multivariate analysis revealed a significant relation between the number of tachyarrhythmic episodes and MMP-9/TIMP-1 (P = .007), PICP/PIIINP (P = .007), and ejection fraction (P = .04). No other significant relation was observed between arrhythmias and the remaining parameters. CONCLUSION: In heart failure, biochemical markers indicative of a deranged equilirium in myocardial collagen deposition/degradation and collagen I/III synthesis are related to ventricular arrhythmogenesis. Further studies are needed to investigate their predictive ability

The use of the multi-electrode duty-cycled radiofrequency ablation catheter PVAC for the ablation of a left atrial tachycardia

The multi-electrode ablation catheter PVAC is used to simplify pulmonary vein isolation in patients undergoing ablation of atrial fibrillation. The use of the PVAC in cases of atrial tachycardia has not been reported before. In the present report, we present the use of the PVAC for the ablation of a left atrial tachycardia following pulmonary vein isolation. This case may suggest that the PVAC could ablate some atrial tachycardias without any adjunctive ablation catheter, given its ability to map, pace and apply energy over a relatively broad area

Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Prevention of atrial-esophageal fistula after catheter ablation of atrial fibrillation

Several measures for prevention of atrial-esophageal fistula formation are available nowadays. Although these measures cannot completely eliminate the risk of fistula, it appears prudent to apply a combination of them during atrial fibrillation ablation. © 2010 Wolters Kluwer Health

Experimental and Clinical Evaluation of a Counterpulsation Device

The counterpulsation technique has been widely used for the as sistance of the acutely failing left ventricle utilizing the intraaortic balloon pump. However, a variety of other counterpulsation devices are available. To evaluate a counterpulsation device several variables need to be considered: (1) experimental and clinical determination of the salutary effects of the device on the left ventricular ejection fraction, cardiac output, aortic pressures, left ven tricular end-diastolic pressure, tension-time index, diastolic pressure-time in dex and endocardial viability ratio; (2) experimental and clinical estimation of the device biocompatibility, and (3) the clinical improvement of the assisted patients. © 1990, Sage Publications. All rights reserved

Optic neuritis and jaccoud&apos;s syndrome in a patient with systemic lupus erythematosus: Case report

Unilateral optic neuritis and Jaccoud&apos;s Syndrome in a 34-year-old woman suffering from systemic lupus erythematosus is presented. We discuss the probable pathophysiological mechanisms of these two uncommon conditions. The most acceptable incriminating factor for optic neuritis is vasculitis. © 1983 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted

The role of Lipoprotein-associated Phospholipase A2 (Lp-PLA2) in cardiovascular disease

Lipoprotein-associated Phospholipase A2 (Lp-PLA2) is an enzyme that belongs to the A2 Phospholipase superfamily and is produced by inflammatory cells that are involved in the process of atherogenesis. Even though there is controversy in current bibliography whether Lp-PLA2 exerts proatherogenic or anti-atherogenic properties, the weight of evidence suggests a pro-atherogenic role for this protein. Lp-PLA2 is detected in human atherosclerotic lesions and elevated Lp-PLA2 levels are associated with an increased risk of cardiovascular events and adverse events in patients with coronary artery disease independently of traditional risk factors and other markers of inflammation. It has been recently shown that direct pharmacological inhibition of Lp-PLA2 activity exerts beneficiary effects on the atherosclerotic process. This finding is most interesting since it could offer a novel target for therapeutic intervention in patients suffering from cardiovascular disease. The purpose of this review article is to report on the role of Lp-PLA2 in cardiovascular diseases and to enlighten the putative pathophysiologic mechanisms by which this protein exerts its effect on cardiovascular function. Additionally, the pharmacological interventions that influence Lp-PLA2 activity and may offer a new approach for the treatment of atherosclerosis will be analyzed. © 2011 Bentham Science Publishers Ltd