Left-sided approach of AV junction ablation for drug refractory atrial fibrillation.

AV junction ablation has been proven effective to treat symptomatic atrial fibrillation refractory to antiarrhythmias or fail of pulmonary vein isolation. However, about 15% of conventional right-sided approach AV junction ablation failed to produce complete heart block. This study aimed to characterize His bundle potential at ablation site during conventional or left-sided approach of AV junction ablation. Twenty symptomatic AF patient (age of 60.5 ± 9.28 and 11 are females) underwent conventional AV junction ablation. If 10 applications of radiofrequency energy are failed, then the ablation was performed by left-sided approach. Seventeen patients are successfully ablated by conventional approach. In 3 patients, conventional was failed but successfully ablated by left-sided approach. The His bundle amplitude at ablation site was significantly larger in left-sided than correspondence right-sided (16.0 ± 4.99 mm vs. 6.9 ± 4.02 mm respectively, p = 0.001, 95% CI -14.0 to -4.3). ROC analysis of His bundle potential amplitude recorded from right-sided revealed that cut off point of > 4.87 mm given the sensitivity of 81.3% and specificity of 53.8% for successful right-sided approach of AV junction ablation. In case of failed conventional approach, the left-sided approach is effective for AV junction ablation. An early switch to the left-sided approach may avoid multiple RF applications in patients with a low amplitude His-bundle potential (< 4.87 mm).

QT dispersion, a simple tool to predict ventricular tachyarrhythmias and/or sudden cardiac death after myocardial infarction.

Recent studies showed contradictive results of the relation between QT dispersion and the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death. In addition, beta adrenoreceptors blocking agents, which are known to decrease the incidence of lethal arrhythmias after myocardial infarction, administered to the majority of patients in those studies population. Since β -blocker as secondary prevention drug was underutilized at National Cardiovascular Center Harapan Kita, this study was performed to find out the relation between QT dispersion and ventricular tachyarrhythmias and/or sudden cardiac death after previous myocardial infarction. The QT interval duration, QT dispersion and clinical variables of 36 postinfarction patients with history of sustained ventricular tachyarrhythmias and/or sudden cardiac death (event group) were compared with 75 postinfarction patients without such events (control group). QT dispersion differed significantly between study groups and was increased in the event group (115 ± 41 msec vs 81 ± 25 msec, p < 0.001). Corrected maximal QT interval duration was also prolonged in the event group (534 ± 56 vs 501 ± 35 msec, p < 0.001). Regression analysis showed that increasing QT dispersion was related to the occurrence of ventricular tachyarrhythmias and/or sudden cardiac death with OR of 3.2, 4, and 5.8 for cut-off point of 80, 90, and 100 msec respectively. The QT dispersion could predict the occurrence of ventricle tachyarrhythmias and/or sudden cardiac death in patient with AMI. This study confirmed that the QTd remain useful in free of beta blocking agents state.

Use of magnesium sulfate in severe bronchial asthma

Four patients were treated with intravenous magnesium sulfate. Magnesium sulfate was used in addition to other drug therapy for bronchial asthma. All 4 patients responded to intravenous magnesium sulfate and tolerated the drug without any side effects. This study illustrated the usef lness and the safety of the drug

Adverse reactions to a single dose of diethylcarbamazine in patients with Brugia malayi infection in Riau Province, West Indonesia.

A study on the adverse reactions, occurring after treating microfilaremic patients infected with B. malayi, revealed that all reacted to a single oral dose of DEC (5 mg/kg). The major reactions were fever, headache, anorexia, abdominal pain, muscle and joint pains, nausea and vomiting. There seemed to be no association between the time of fever onset and microfilarial density, but the number of cases observed was too small to make any firm conclusion. There was a tendency for more severe reactions to occur in patients with higher microfilaria counts. Local reactions, probably due to destruction of adult worms, were seen in 3 patients. The reactions were serious enough to necessitate the patients spending approximately 48 hours in bed.