Cardiac rate normalization in chronic atrial fibrillation: comparison of long-term efficacy of treatment with amiodarone versus AV node ablation and permanent His-bundle pacing.

Chronic atrial fibrillation (AF) is a common arrhythmia with significant morbidity and mortality. AF has been the subject of considerable attention and intensive clinical research in recent years. Current opinion on the management of AF favors the restoration and maintenance of normal ventricular rhythm. This has several potential benefits, including the alleviation of arrhythmia-associated symptoms and hemodynamic improvements. Maintenance of frequents normalization of ventricular rhythm (NVR) can be achieved with antiarrhythmic drug therapy or with AV node radiofrequency ablation (RFA) and permanent ventricular pacing. Recent interest has focused on the use of class III antiarrhythmic agents, such as amiodarone hydrochloride. This investigation compared amiodarone to AV node RFA and permanent pacing of the His-bundle area in maintaining NVR in patients with resistant chronic AF. After 12 months of treatment with amiodarone (200 to 400 mg/d) 30 % of patients remained in NVR, 30 % were in transitional phase of improvement, and 40 % showed negative effect. Only a few patients in this group developed ocular or hepatic side effects. On one year follow-up was achieved in 100 % of cases without any clinically significant side effects being seen. In conclusion, analysis of the results of this study suggests that low-dose amiodarone is well tolerated in the management of chronic AF in a selected patient population. The more aggressive interventional radiofrequency ablation technique is significantly more effective and more reliable in the long-term clinical treatment of drug-resistant AF.

Prevalence of hypertension in Lithuanian mariners.

Several international studies from Spain, the Netherlands, Poland, Croatia, and Finland indicate contradicting findings regarding cardiovascular dysfunction among seamen, deep sea fishermen, and harbor workers. The purpose of the present survey was to evaluate the prevalence of hypertension in a selected group of Lithuanian seamen. The survey was conducted during a one year period and involved sailors from commercial, passenger, and fishing boats. The survey took into account the sailors' marital status, education, professional rank and duty, and length of stay at sea. It also included demographical data, complete family health history, the sailor's awareness about their health in general, and awareness about their blood pressure in particular. Their dietary habits, changes in body weight, the history of alcohol intake and tobacco usage were also recorded. Analysis of our data indicates that 44.9% of Lithuanian mariners suffer from a clinically significant elevation of blood pressure, as compared to 53% of the general population of Lithuania. Some of the leading risk factors are: a high cholesterol diet and increased body mass index (BMI), smoking, alcohol abuse, family situation and level of education. The high prevalence of the cardiovascular risk factors was to be found related to ischemic heart disease and cerebrovascular illness. This may be influenced by poor eating habits, poor health awareness and other social and environmental factors which are common to seamen. Increased blood pressure is a widespread condition that affects a large portion of the population in developed countries. It is an important risk factor for cardiovascular and cerebrovascular disease, as well as a significant preventable cause of mortality. According to the World Health Organization (WHO), hypertension is a risk factor for cardiovascular disease, which accounts for an estimated 17 million deaths each year. With hypertension, the risk of stroke increases 2.6-3.8 times, the risk of ischemic heart disease (IHD)--2.0-2.2 times, and that of congestive heart failure (CHF)--3.0-4.0 times. Hypertension is often accompanied by other cardiovascular risk factors such as dyslipidemia, smoking, diabetes and increased body mass index (BMI). When hypertension is present in conjunction with other risk factors, the risk of mortality associated with IHD can increase tenfold. On the other hand, risk factors such as an increased BMI, smoking, alcohol abuse, lack of exercise and a diet high in salt and fatty foods can themselves play an instrumental role in the etiology of hypertension. Several studies have been performed on the prevalence of hypertension among the general population in Lithuania, which is higher than that of most other European countries. Reviews performed by the programs CINDI (Countrywide Integrated Noncommunicable Disease Intervention) and MONICA (MONItoring CArdiovascular Disease) determined that about half of all studied persons of middle age in Lithuania were hypertensive. Our work is the first study seeking to examine the prevalence of hypertension among Lithuanian seamen, as well as its association with various risk factors and dependence on demographic indices.