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Editor: Asher Kimchi, MD

Intravenous Hydrocortisone Reduces the Incidence of Atrial Fibrillation (AF) after Cardiac Surgery
The incidence of AF has been reported to be 20-40% after coronary bypass graft (CABG) surgery, and is even higher after valve and combined valve and bypass surgery. A potential mechanism for the AF is an exaggerated inflammatory response, demonstrated by increased levels of complement, C-reactive protein complex, and number of white blood cells in patients who develop AF. Jari Halonen, MD et al from Kuopio University Hospital in Kuopio, Finland investigated whether intravenous corticosteroids administered after cardiac surgery prevents AF after cardiac surgery. Their results, published in the April 11, 2007 issue of the Journal of the American Medical Association concluded that intravenous hydrocortisone reduced the incidence of AF after cardiac surgery. MOREĽ

Pulse Pressure is a Risk Factor for New-Onset Atrial Fibrillation (AF)
Atrial fibrillation is associated with an increased risk of mortality and stroke, and every one in four people will develop AF at some point in their lifetime. Already recognized clinical risk factors for AF include advancing age, increased systolic blood pressure, diabetes, hypertension, heart failure, valvular disease, myocardial infarction, and obesity. Echocardiographic risk factors for AF include left atrial enlargement, increased left ventricular wall thickness, and impaired left ventricular systolic function. Gary F. Mitchell, MD et al from the Cardiovascular Engineering Inc. in Waltham, MA investigated whether pulse pressure, a reflection of aortic stiffness, could be a potentially easily modifiable risk factor for AF. Their study, published in the February 21, 2007 issue of The Journal of the American Medical Association, found that pulse pressure is in fact an important risk factor for incident AF in a community-based sample. MOREĽ

Radiofrequency Catheter Ablation Should Be Considered a First-Line Therapy After the First Episode of Symptomatic Atrial Flutter
Until now, there have been no studies comparing amiodarone therapy and radiofrequency catheter ablation (RFA) for patients who have had one episode of atrial flutter (AFL). Antoine Da Costa, MD, PhD et al from the University Jean Monnet in Saint-Etienne, France did a study comparing the efficacy and safety of first-line RFA versus AFL therapy. The study found that RFA should be considered a first-line therapy even after the first episode of symptomatic AFL due to better long-term success rate, the same risk of subsequent AF and fewer secondary effects. The study was published in the October 17, 2006 issue of Circulation. MOREĽ

Mutations in the Connexin 40 Gene, GJA5, Predisposes Patients to Idiopathic Atrial Fibrillation
Atrial Fibrillation is the most common type of cardiac arrhythmia characterized by erratic electrical activation of the atrial myocardium, resulting in loss of effective contractility and an increase in clot formation. Michael H. Gollob et al from the University of Ottawa Heart Institute studied the genetic basis of atrial fibrillation as it relates to mutations in the connexin 40 gene, GJA5. Their results, published in the June 22, 2006 issue of The New England Journal of Medicine, found that mutations in GJA5 may predispose patients to idiopathic atrial fibrillation by impairing gap-junction assembly or electrical coupling. MOREĽ

In Pediatric Patients With Cardiac Arrest, Survival Outcomes Were Higher Among Patients in Whom Ventricular Fibrillation or Tachycardia was Present Initially Than Among Those in Whom it Developed Subsequently
In children, cardiac arrests are typically presented secondary to a progressive respiratory failure or shock, rather than as a primary arrhythmogenic event as seen in adults.
Ventricular fibrillation or tachycardia can also occur
during cardiopulmonary resuscitation (CPR) for asystole
or pulseless electrical activity as a reperfusion
arrhythmia. A study by Robert A. Berg M.D et al, from
the Steele Children’s Research Center in Arizona, showed that a presentation of ventricular fibrillation or
tachycardia at the beginning of cardiac arrest results
in a better survival outcome than if the ventricular
fibrillation presented subsequently during CPR. The
study was published in the June 1, 2006 issue of The New England Journal of Medicine.

No Significant Difference in the Single-Chamber Versus Dual-Chamber Pacing for High Grade Atrioventricular BlockCardiac pacing is a treatment for high-grade atrioventricular heart block. There is a debate about whether Single-Chamber or Dual-Chamber pacing is the most appropriate form of treatment. While dual-chamber is associated with lower incidence of atrial fibrillation, stroke and heart failure in non-randomized studies, Dr. William Toff et al from the University of Leicester, UK conducted a randomized, parallel-group trial comparing patients who received single-chamber versus double-chamber pacers. The study, published in the July 14, 2005 issue of The New England Journal of Medicine, indicates no significant difference between the group with dingle-chamber pacing and that with dual-chamber pacing in the rates of atrial fibrillation, heart failure or a composite of stroke, transient ischemic attack or other thromboembolism. MORE…

Amiodarone is Superior to Sotalol for Maintaining Sinus Rhythm in Patients with Atrial Fibrillation 

Transcatheter Ablation Is Feasible in Atrial Fibrillation Patients with Prosthetic Mitral Valves

Prophylactic Use of an Implantable Cardioverter-Defibrillator after Acute Myocardial Infarction Does Not Reduce Overall Mortality

Outpatient Treatment of Recent-Onset Atrial fibrillation with Flecainide and Propafenone Has Been Shown to be Safe and Feasible in Terminating Atrial Fibrillation 

Catheter Ablation for Atrial Fibrillation Improves Cardiac Function in Patients with Congestive Heart Failure

Heart gone haywire blamed in some sudden infant deaths

Terrorist attacks increased dangerous irregular heartbeats

Studies Suggest Rate Control Equal to Rhythm Control in Some AF Patients

Prophylactic Catheter Ablation Found to Reduce Risk of Arrhythmia in Asymptomatic Children with Wolff-Parkinson-White Syndrome

Addition of Antiplatelet to Anticoagulant Therapy Increases Effectiveness in Patients with Valvular and Non-valvular Atrial Fibrillation 





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