Arrhythmia/EP

The data stop here: Primary-prevention ICDs for the very elderly

1 COMMENT - Aug 26, 2008 12:00 EDT

Many patients getting the devices today are decades older than those in the clinical trials on which the US guidelines are based. Some say that matters, so it should be explored in clinical trials. Others say there have been trials enough. (Sweeney MO et al. J Cardiovasc Electrophysiol; published online before print June 12, 2008.)

Boston, MA - An 85-year-old presents with symptomatic bradycardia and is considered a likely candidate for a pacemaker. At further evaluation, the patient is found to have an LV ejection fraction of 32%. With the patient meeting the guidelines' LVEF criteria for an implantable cardioverter-defibrillator (ICD), the decision is made on the spot to give the patient, not a single- or dual-chamber pacemaker, but an ICD programmed to manage the sinus-node disease (SND). Read full article »

(Sweeney MO et al. J Cardiovasc Electrophysiol; published online before print June 12, 2008.)

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Arrhythmia/EP

Device Therapy for Heart Failure: Debating the Guidelines - Which Should We Really Follow?

Oct 8, 2008 14:50 EDT

Join Drs Yancy, Jessup, Lindenfeld, Saxon, and Stevenson as they discuss how similar databases can be interpreted differently. Device-based therapy is effective when selected for the right patient; but there is considerable underuse of devices, in part due to ambiguity in the guidelines.

Arrhythmia/EP

The Evolution of ICD and CRT Clinical Trials and Their Impact on Clinical Practice

Sep 30, 2008 15:00 EDT

The overall heart failure-related mortality rate in the United States has almost doubled in the past two decades. Which patients will benefit the most from the use of ICDs? Join our panel of experts, Drs Abraham, Fonarow, Francis, and Gold as they discuss the latest evidence from clinical trials.

Clinical cardiology

ICD Therapy: New Data on Quality of Life and Outcomes

Sep 10, 2008 11:00 EDT

New data on quality of life and long-term prognosis after ICD implantation for primary prevention was recently published in the New England Journal of Medicine. Join Drs Bhatt, Harrington, and Prystowsky as they review this new data and discuss the clinical context of these studies.

Arrhythmia/EP

Improving Cardiovascular Outcomes in AF

2 COMMENTS - Sep 3, 2008 14:00 EDT

For all the debates on rate vs rhythm control, contemporary analyses show little change in atrial fibrillation (AF) mortality rates in the past 20 years. Will recent developments, including novel pharmacologic agents and advances in catheter ablation, translate into meaningful clinical benefit for patients? Drs Camm, Falk, Knecht, and Hohnloser each give presentations on key issues relating to the contemporary management of patients with AF.

Arrhythmia/EP

Stroke in Pharmacologically-Managed AF

1 COMMENT - Sep 3, 2008 14:00 EDT

The rate vs rhythm AF trials suggest that rhythm-managed AF patients experience more strokes possibly due to cessation of warfarin in patients with unrecognized, asymptomatic AF. Stuart Connolly presents the ESC late-breaking ATHENA findings that challenge this viewpoint and Drs Fox, Dorian, and Steg discuss the implications and possible mechanisms.

Arrhythmia/EP

Hypertrophic cardiomyopathy (HCM) affects over one million Americans... what do you know about HCM?

9 COMMENTS - Jul 8, 2008 09:00 EDT

Hypertrophic cardiomyopathy (HCM) is a complex but common genetic heart disease that affects nearly one in 500 people in the US and often goes undiagnosed. It is characterized by abnormal thickening of the heart's chamber walls and is the most common cause of sudden cardiac death in people under age 30. Please take a moment to share your perspective on the role of HCM management with theheart.org.

Clinical cardiology

Utilization of ICD therapy: The current state of the industry

5 COMMENTS - Jun 27, 2008 10:58 EDT

Dr Eric N Prystowsky MD discusses the current utilization of ICD guidelines and strategies to improve patient care.

Arrhythmia/EP

Warfarin warning: Shortfalls in anticoagulation for AF up risks of ICH and embolic stroke

2 COMMENTS - Oct 10, 2008 12:45 EDT

Documentation of the care of patients in a nationwide health plan suggests that less than half of patients with atrial fibrillation are prescribed an anticoagulant. (Walker AM, Bennett D. Heart Rhythm 2008;5:1365-1372.)

Interventional/Surgery

Miniaturized heart pumps: Difference between life and death in small children

Sep 30, 2008 15:45 EDT

Reporting on his own initial experience with a miniaturized ventricular assist device used as a bridge to transplant in small children, a leading pediatric heart surgeon is hoping that the pump—widely available in Europe—will soon be approved for use in the US. (Gandhi SK et al. Circulation 2008; 118:S89-S93.)

Arrhythmia/EP

Out-of-hospital cardiac arrest: Location is all

Sep 23, 2008 16:00 EDT

A new analysis of out-of-hospital cardiac arrest in 10 areas in North America has found a fivefold difference in survival rates. The researchers say an estimated 15 000 premature deaths could be prevented each year if survival could be increased in those places not performing well. A related article contends that to try to improve outcomes, attention should be focused on those most likely to survive. (Nichol G et al. Sasson C et al. JAMA 20082; 300:1423-1431, 1432-1438.)

Arrhythmia/EP

ICD effectiveness: Do patients appreciate their limits? The debate continues

Sep 22, 2008 17:00 EDT

A review casts a critical eye on how ICDs are used in the US and argues that their benefits have been overstated; a commentary from a key figure behind the latest device-therapy guidelines takes exception. (Tung R et al. J Am Coll Cardiol; published online before print September 22, 2008.)

Acute Coronary Syndrome

Air pollution is a risk factor for ST-segment depression in coronary patients

Sep 9, 2008 17:30 EDT

The subclinical effects of traffic- and non-traffic-related pollution suggest that patients discharged following MI or acute coronary syndrome would be protected if air-pollution levels were lower or if they avoided needless exposure to pollution, report investigators. (Chuang KJ et al. Circulation; published online before print September 8, 2008.)

Heart failure

REVERSE at 18 months: Questions about CRT for mild heart failure remain

Sep 8, 2008 11:45 EDT

The trial's extended follow-up of its European patients strengthens its earlier evidence that CRT can reverse cardiac remodeling even in NYHA class 1-2, and its suggestions of a clinical benefit continue to inspire optimism. (European Society of Cardiology Congress 2008.)

Arrhythmia/EP

Medtronic ICD software upgrade targets Sprint Fidelis lead-fracture issue

Sep 5, 2008 17:00 EDT

Heart failure

ICD discharges: Underappreciated meaning highlighted in SCD-HeFT analysis

Sep 4, 2008 09:45 EDT

The risk of death from any cause climbed whenever a primary-prevention ICD discharged, but the shocks were a warning, not a killer; another secondary analysis of the trial suggests that patients' quality of life didn't suffer because they had been implanted with ICDs. (Pool JE et al. Mark DB et al. N Engl J Med 2008; 359:1009-1017, 999-1008.)

Arrhythmia/EP

ATHENA analysis suggests cut in stroke risk with dronedarone for atrial fib

2 COMMENTS - Sep 3, 2008 11:45 EDT

The post hoc finding, which was relative to placebo, is unusual for an antiarrhythmic agent. The investigational drug is envisioned as a potentially safer alternative to amiodarone. (European Society of Cardiology Congress 2008.)

Lipid/Metabolic

FDA renews caution against mixing simvastatin >20 mg/day and amiodarone

Aug 11, 2008 15:45 EDT

Heart failure

Marker of autonomic dysfunction predicts sudden-death risk in heart failure

1 COMMENT - Aug 7, 2008 16:00 EDT

Previously more explored as a prognostic marker in the post-MI setting, abnormal heart-rate turbulence is being eyed as a risk stratifier in candidates for primary-prevention ICDs. (Cygankiewicz I et al. Heart Rhythm 2008; 5:1095-1102.)

Arrhythmia/EP

Light-to-moderate physical activity associated with lower risk of AF in older adults

Aug 6, 2008 15:15 EDT

Physical activity has been previously reported to increase the risk of AF, but only intense exercise and endurance training have been evaluated, usually in younger adults. This study, say investigators, suggests that activities such as walking, gardening, and outdoor chores could be employed as a potential preventive measure to reduce the incidence of AF in the particularly high-risk and growing population of older adults. (Mozaffarian D et al. Circulation; published online before print August 5, 2008.)

Arrhythmia/EP

Routine shock-energy testing in primary-prevention ICDs questioned—again

1 COMMENT - Aug 4, 2008 17:00 EDT

Defibrillation-threshold testing in SCD-HeFT had no effect on the efficacy of later appropriate shocks or on mortality. Also, the PREPARE study, of a one-size-fits all ICD-programming strategy, aimed at reducing device-related morbidity, is published. (Blatt JA et al. Wilkoff BL et al. J Am Coll Cardiol 2008; 52:551-556, 541-550.)

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