ABSTRACT
Electrical cardioversion is the most effective and safe method to restore sinus rhythm in patients with persistent AF. However, at least 25% of electrical cardioversions are unsuccessful. The aim of the present study was to evaluate, in a prospective, randomized and double-blind study, the efficacy of a pretreatment with intravenous flecainide in patients who underwent electrical cardioversion. Fifty-four consecutive patients with persistent AF, mean arrhythmia duration 8 (mean 3-18) weeks, were randomized in two groups. In the first group (n = 26), patients received flecainide (2 mg/kg as a 30-minute IV infusion) before electrical cardioversion. In the second group (n = 28), 100 mL IV infusion of 5% glucose was administered 30 minutes before electrical cardioversion. The study evaluated the (1). acute efficacy of electrical cardioversion, (2). mean and maximal energy required, (3). mean number of shocks needed, and (4). incidence of complications. The two groups were similar in terms of age, sex, mean AF duration, left ventricular systolic function, atrial dimension, and cardiovascular risk factors. Seventy-seven percent of patients recovered sinus rhythm with electrical cardioversion. No statistical difference was noted between the two groups: flecainide 19/26 (73%) versus placebo 23/28 (82%). No significant differences were found concerning mean or maximal energy and number of shocks required. No major complications were observed. After a 30-day follow-up, 54% of patients maintained sinus rhythm with no difference between the two groups. Pretreatment with intravenous flecainide before electrical cardioversion is not useful in reducing technical failure of cardioversion, however, flecainide does not diminish the effectiveness of electrical cardioversion.
Subject(s)
Anti-Arrhythmia Agents/therapeutic use , Atrial Fibrillation/therapy , Electric Countershock , Flecainide/therapeutic use , Aged , Anti-Arrhythmia Agents/administration & dosage , Anti-Arrhythmia Agents/adverse effects , Atrial Fibrillation/drug therapy , Cardiac Output/physiology , Double-Blind Method , Electric Countershock/adverse effects , Electric Countershock/methods , Female , Flecainide/administration & dosage , Flecainide/adverse effects , Follow-Up Studies , Heart Atria/pathology , Humans , Infusions, Intravenous , Male , Placebos , Premedication , Prospective Studies , Risk Factors , Systole/physiology , Treatment OutcomeABSTRACT
OBJECTIVES: The relative value of classic markers, myocardial damage variables, and levels of acute-phase reactants in establishing the pre-discharge prognosis of acute coronary syndrome without ST-segment elevation was analyzed. METHOD: We prospectively studied 385 consecutive patients admitted from our chest pain unit with a high-probability diagnosis of acute coronary syndrome without ST-segment elevation. The clinical and electrocardiographic data, myocardial damage markers (troponin I, CK-Mb mass, myoglobin), and acute-phase reactants (high-sensitivity C-reactive protein, fibrinogen) were recorded. RESULTS: During admission, 15 deaths (3.9%) and 16 complicative infarctions (4.2%) occurred, for a total of 31 major events (death and/or infarction: 8.1%). Age (p = 0.03), insulin-dependent diabetes (p = 0.009), and C-reactive protein (p = 0.05) were independently related to death. Fibrinogen was related to infarction (p = 0.01); by fibrinogen quartiles: 1.4%; 1.4%; 2.9%, and 11.7% (p = 0.02). Age (p = 0.01), insulin-dependent diabetes (p = 0.02), and C-reactive protein (p = 0.04) were independent predictors of major events; by C-reactive protein quartiles: 1.4%; 5.5%; 5.4%, and 16.7% (p = 0.004). Troponin I was related to major events (p = 0.03), but it was not an independent predictor. CONCLUSIONS: Acute-phase reactants add independent information to clinical variables in the short-term risk stratification of patients with an acute coronary syndrome. The predictive power of troponins is lower than that of other variables.
Subject(s)
Acute-Phase Proteins , Angina, Unstable , Biomarkers , Electrocardiography , Myocardial Infarction , Acute Disease , Adult , Age Factors , Aged , Aged, 80 and over , Angina, Unstable/blood , Angina, Unstable/diagnosis , Angina, Unstable/mortality , C-Reactive Protein/analysis , Data Interpretation, Statistical , Diabetes Mellitus, Type 1/complications , Fibrinogen/analysis , Humans , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/diagnosis , Myocardial Infarction/mortality , Prognosis , Risk Factors , Syndrome , Time Factors , Troponin I/bloodABSTRACT
Objetivos. Se analiza el papel relativo de los marcadores clásicos, de las variables de daño miocárdico y reactantes de fase aguda en el pronóstico prealta del síndrome coronario agudo sin elevación del segmento ST.Método. Se estudió prospectivamente a 385 pacientes consecutivos ingresados desde nuestra unidad de dolor torácico con el diagnóstico de alta probabilidad de síndrome coronario agudo sin elevación del segmento ST. Se recogieron las variables clínicas, electrocardiográficas, indicadores de daño miocárdico (troponina I, Ck-Mb masa, mioglobina) y reactantes de fase aguda (proteína C reactiva de alta sensibilidad y fibrinógeno).Resultados. Durante el ingreso hospitalario se detectaron 15 fallecimientos (3,9 por ciento), 16 infartos complicativos (4,2 por ciento) y 31 episodios mayores (fallecimiento y/o infarto: 8,1 por ciento). Fueron predictores independientes de fallecimiento la edad (p = 0,03), la diabetes insulinodependiente (p = 0,009) y la proteína C reactiva (p = 0,05). El fibrinógeno (p = 0,01) predijo infarto; por cuartiles: 1,4; 1,4; 2,9, y 11,7 por ciento (p = 0,02). La edad (p = 0,01), la diabetes insulinodependiente (p = 0,02) y la proteína C reactiva (p = 0,04) fueron predictores independientes de episodio mayor; por cuartiles de proteína C reactiva: 1,4; 5,5; 5,4, y 16,7 por ciento (p = 0,004). La troponina I se relacionó con una mayor tasa de episodios mayores (p = 0,03), pero no fue un predictor independiente.Conclusiones. Los reactantes de fase aguda añaden información independiente a las variables clínicas en la estratificación de riesgo a corto plazo de los pacientes con síndrome coronario agudo. El poder predictor de la troponina disminuye al ser comparado con otras variables (AU)
Subject(s)
Middle Aged , Adult , Aged , Aged, 80 and over , Humans , Biomarkers , Myocardial Infarction , Acute-Phase Proteins , Angina, Unstable , Electrocardiography , Risk Factors , Time Factors , Syndrome , Troponin I , Prognosis , C-Reactive Protein , Data Interpretation, Statistical , Acute Disease , Age Factors , Fibrinogen , Diabetes Mellitus, Type 1ABSTRACT
Objetivos. El objetivo del presente estudio ha sido relacionar la reserva contráctil en la zona del infarto con la disfunción basal y la estenosis coronaria residual. Métodos. Se han estudiado 95 pacientes con un primer infarto de miocardio. Se ha efectuado una ventriculografía de contraste basal y tras 7,5 µg/kg/min de dobutamina, y una coronariografía. Mediante el método de la línea central se ha calculado la extensión de la disfunción (porcentaje de cuerdas con disfunción en el territorio de la arteria del infarto) y su severidad máxima (máximo de unidades de desviación estándar [DE] por debajo de la referencia). Se ha cuantificado la reducción de la extensión tras dobutamina. Resultados. Al incrementarse la severidad de la disfunción, ha disminuido la magnitud de la respuesta a la dobutamina ( 2 DE [n = 12] = 33 ñ 19 por ciento, > 2 DE 3 DE [n = 20] = 20 ñ 16 por ciento, > 3 DE 4 DE [n = 35] = 16 ñ 19 por ciento, > 4 DE ñ 5 DE [n = 15] = 9 ñ 13 por ciento, > 5 DE [n = 13] = 3 ñ 4 por ciento, p = 0,0001) y el número de pacientes con respuesta significativa ( 15 por ciento) positiva ( 2 DE = 12 [100 por ciento], > 2 DE 3 DE = 11 [55 por ciento], > 3 DE 4 DE = 17 [49 por ciento], > 4 DE 5 DE = 3 [20 por ciento], > 5 DE = 0 por ciento, p 5 DE (alta prevalencia de respuestas negativas), el test de la dobutamina no parece indicado. La presencia de estenosis coronaria residual no limita la reserva contráctil ante bajas dosis de dobutamina (AU)
