Amiodarone and digitalis: An odd couple in a tachycardiomyopathic patient

Amiodarone is one of the most used anti-arrhythmic drug for rate and rhythm control in atrial fibrillation. Unfortunately, it has also well-known pro-arrhythmic properties and it has been reported as a common cause of malignant ventricular tachyarrhytmias, especially torsade de pointes. Proarrhytmic effects of amiodarone are greatly increased by other concomitant factors, such as ventricular dysfunction and concomitant treatment with digitalis. Current evidence shows how amiodarone and digitalis together are associated with torsade de pointes in ischemic patients with heart failure. The present case report describes, for the first time, how amiodarone and digital can concur in producing torsade de pointes also in a tachycardiomyopathic patient with no coronary artery disease

New anthyarrhythmic drugs for atrial fibrillation

Atrial fibrillation (AF) is a common arrhythmia associated with increased mortality and morbidity. Different studies have shown no significant difference between rhythm and rate control strategies in terms of mortality. Moreover, the use of antiarrhythmic drugs is afflicted by cardiac and extracardiac toxicity and related costs of hospitalization. Nevertheless, some patients require a rhythm-control strategy and new anti-AF agents are being sought. Only few novel agents showed promising results in term of efficacy and safety. Dronedarone and vernakalant are two of these compounds, respectively introduced for the chronic and acute rhythm control of AF. This article will review pharmacology and clinical evidence on the use of dronedarone and vernakalant and will mention currently investigated new antiarrhythmic drugs

Intravenous vernakalant for the rapid conversion of recent onset atrial fibrillation: systematic review and meta-analysis

Atrial fibrillation is the most common cardiac arrhythmia and is associated with increased mortality and morbidity. Conversion to sinus rhythm is usually appropriate in patients with acute, symptomatic atrial fibrillation in order to reduce symptoms and prevent complications. Electrical cardioversion is the most used and widespread technique, but requires deep sedation and a fasting state. Pharmacological alternatives are burdened by a delayed onset of action and potential proarrhythmic effects. Therefore, new therapeutic options are being sought. Among those, vernakalant, showed a good efficacy profile and a short onset of action, but with conflicting evidence regarding potential serious adverse events. This drug profile will summarize the pharmacology behind this new drug and review recent evidence in terms of safety and efficacy

Exercise: a "new drug" for elderly patients with chronic heart failure

Patients with chronic heart failure (CHF) experience progressive deterioration of functional capacity and quality of life (QoL). This prospective, randomized, controlled trial assesses the effect of exercise training (ET) protocol on functional capacity, rehospitalization, and QoL in CHF patients older than 70 years compared with a control group. A total of 343 elderly patients with stable CHF (age, 76.90±5.67, men, 195, 56.9%) were randomized to ET (TCG, n=170) or usual care (UCG, n=173). The ET protocol involved supervised training sessions for 3 months in the hospital followed by home-telemonitored sessions for 3 months. Assessments, performed at baseline and at 3 and 6 months, included: ECG, resting echocardiography, NT-proBNP, 6-minute walk test (6MWT), Minnesota Living with Heart Failure Questionnaire, and comprehensive geriatric assessment with the InterRAI-HC instrument. As compared to UCG, ET patients at 6 months showed: i) significantly increased 6MWT distance (450±83 vs. 290±97 m, p=0.001); ii) increased ADL scores (5.00±2.49 vs. 6.94±5.66, p=0.037); iii) 40% reduced risk of rehospitalisation (hazard ratio=0.558, 95%CI, 0.326-0.954, p=0.033); and iv) significantly improved perceived QoL (28.6±12.3 vs. 44.5±12.3, p=0.001). In hospital and home-based telemonitored exercise confer significant benefits on the oldest CHF patients, improving functional capacity and subjective QoL and reducing risk of rehospitalisation

Symptomatic atrial fibrillation and risk of cardiovascular events:data from the Euro Heart Survey

Aims Atrial fibrillation (AF) is associated with a wide range of clinical presentations. Whether and how AF symptoms can affect prognosis is still unclear. Aims of the present analysis were to investigate potential predictors of symptomatic AF and to determine if symptoms are associated with higher incidence of cardiovascular (CV) events at 1-year follow-up. Methods and results The Euro Heart Survey on Atrial Fibrillation included 3607 consecutive patients with documented AF and available follow-up regarding symptoms status. Patients found symptomatic at baseline were classified into still symptomatic (SS group; n = 896) and asymptomatic (SA; n = 1556) at 1 year. Similarly, asymptomatic patients at baseline were classified into still asymptomatic (AA group; n = 903) and symptomatic (AS group; n = 252) at 1 year. Demographics, as well as clinical variables and medical treatments, were tested as potential predictors of symptoms persistence/development at 1-year. We also compared CV events between SS and SA groups, and AS and AA groups at 1-year follow-up. Both persistence and development of AF symptoms were associated with an increased risk of CV hospitalization, stroke, heart failure worsening, and thrombo-embolism. AF type, hypothyroidism, chronic heart failure, and chronic obstructive pulmonary disease (COPD), were independently associated with an increased risk of symptomatic status at 1-year follow-up between SS and SA groups. Conclusion Persistence or development of symptoms after medical treatment are associated with an increased risk of CV events during a 1-year follow-up. Type of AF, along with hypothyroidism, COPD and chronic heart failure are significantly associated with symptoms persistence despite medical treatment

Performance assessment of medical and non-medical CPAP interfaces used during the COVID-19 pandemic

Background: At the beginning of 2020, a high number of COVID-19 cases affected Italy in a short period, causing a difficult supply of medical equipment. To deal with the problem, many healthcare operators readapted different masks to medical devices, but no experiment was conducted to evaluate their performance. The aims of our study were: to assess the performances of three masks and a CPAP helmet in their original configuration and after modifications, in the maintenance of mean pressure and half-amplitude variations using different PEEP valves and to analyse the impact of antibacterial (AB) or antibacterial-viral (ABV) pre-valve PEEP filters on the effective PEEP delivered to the patients. Four pressure ports were installed on each mask (three on helmet), mean values and half amplitudes of pressure were recorded. Tests were performed with any, AB, ABV filter before the PEEP valve. CPAP helmet was the most efficient interface producing more stable mean pressure and less prominent half-amplitude variations but the non-medical masks, especially after the modifications, maintained a stable mean pressure value with only a moderate increase of half-amplitude. The use of AB and ABV filters, produced respectively an increase of 2,23% and 16.5% in mean pressure, compared to no filter condition. CPAP helmet is the most reliable interface in terms of detected performance, but readapted masks can assure almost a similar performance. The use of ABV filters before the PEEP valve significantly increases the detected mean pressure while the AB filters have almost a neutral effect