Cardiac electrophysiology review最新文献

{"title":"Ischemic Cardiomyopathy: Simultaneous Epicardial and Endocardial Mapping and Ablation","authors":"R. Jiang, R. Tung","doi":"10.1007/978-3-030-28533-3_105","DOIUrl":"https://doi.org/10.1007/978-3-030-28533-3_105","url":null,"abstract":"","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"46 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80075620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ischemic Ventricular Tachycardia","authors":"M. Hutchinson","doi":"10.1007/978-3-030-28533-3_104","DOIUrl":"https://doi.org/10.1007/978-3-030-28533-3_104","url":null,"abstract":"","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"252 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75842404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrioventricular Reentrant Tachycardia","authors":"M. Prabhu, J. Kalman","doi":"10.1007/978-3-030-28533-3_61","DOIUrl":"https://doi.org/10.1007/978-3-030-28533-3_61","url":null,"abstract":"","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77356128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrioventricular Reentrant Tachycardia","authors":"Waseem Y Barham, R. Thakur","doi":"10.1007/978-3-030-28533-3_63","DOIUrl":"https://doi.org/10.1007/978-3-030-28533-3_63","url":null,"abstract":"","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79992747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathophysiology of atrial fibrillation","authors":"S. Nattel","doi":"10.1002/9781119963868.CH2","DOIUrl":"https://doi.org/10.1002/9781119963868.CH2","url":null,"abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in the clinic. It is often associated with hemodynamic and neurohormonal cardiovascular abnormalities, including heart failure (HF), hypertension, valvular and ischemic heart disease. These derangements cause or promote the development of AF triggers and atrial remodeling giving rise to the arrhythmogenic substrate. Rapid activation of the atria during AF leads to further electrical and structural remodeling, thus facilitating the maintenance of AF. For his reason, AF is said to beget-AF. Pulmonary veins are the prime source for AF trigger(s) and may also be the source for AF drivers. Pulmonary vein sleeves are thin muscular structures and as such are sensitive to pressure and volume overload-induced stretch, which may account for their exceptional arrhythmogenic proclivity. Long-term maintenance of AF is believed to be due largely to a reentrant mechanism(s), but direct evidence is often lacking and the controversy continues. The development and maintenance of AF are multifactorial and involve dynamic pathophysiologic processes which are in many cases not well defined or understood. This chapter reviews our current understanding of pathophysiology of AF.","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"49 3","pages":"20-34"},"PeriodicalIF":0.0,"publicationDate":"2011-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1002/9781119963868.CH2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50780786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Do anticoagulation management services improve care? Implications of the Managing Anticoagulation Services Trial.","authors":"David B Matchar","doi":"10.1023/B:CEPR.0000023144.60821.d1","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023144.60821.d1","url":null,"abstract":"<p><p>An Anticoagulation Clinic Service (ACS) has been proposed as one strategy for improving warfarin treatment for patients with atrial fibrillation. In the Managing Anticoagulation Services Trial (MAST), ACSs meeting specifications for high quality care were established in six managed care organizations (MCOs) which had the patients and resources to support this initiative. The trial followed 1165 patients age >or=65 years who had atrial fibrillation as the primary reason for anticoagulation and were enrolled in a participating MCO. The 593 patients in the intervention group saw physicians in a practice cluster which had randomly been assigned to have access to an ACS. These physicians used the ACS on average for about 48% of eligible patients. The 572 patients in the control group received care from physicians in a practice cluster which could not refer patients to the ACS established for the trial but was otherwise unrestricted. The two clusters were compared on the proportion of time warfarin-treated patients were in the target range (2-3) prothrombin time-international normalized ratio (INR) during a 9-month baseline and a 9-month follow-up period. Among patients ( n = 264) for whom data were available for both periods, the changes in percentages of time in the target range were similar in the intervention cluster (baseline: 47.7%; follow-up 55.6%) and in the control cluster (baseline: 49.1%; follow-up: 52.3%; intervention effect: 5%; 95% confidence interval: -5% to 14%; P = 0.32). In both practice clusters, patients had subtherapeutic INR values (1.5 to 1.99) about one fourth of the time. Providing an ACS in a managed care setting did not appear to improve anticoagulation care over the usual care provided at the sites in this trial but could be a reasonable consideration in a practice setting where time in target range is less than 50%. A higher rate of utilization and a more aggressive stance toward subtherapeutic INR values could potentially enhance the effectiveness of an ACS.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"379-81"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023144.60821.d1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24457032","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atrial arrhythmia burden as an endpoint in clinical trials: is it the best surrogate? Lessons from a multicenter defibrillator trial.","authors":"David E Euler,&nbsp;Paul A Friedman","doi":"10.1023/B:CEPR.0000023138.85821.63","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023138.85821.63","url":null,"abstract":"<p><p>Therapies to treat atrial tachyarrhythmias need to be evaluated in controlled, randomized clinical trials in order to optimize patient outcomes. If the maintenance of sinus rhythm is the ultimate goal, then atrial tachyarrhythmia burden may serve as a useful endpoint. Atrial tachyarrhythmia burden is defined as the total duration of all atrial tachyarrhythmias divided by the follow-up time and includes asymptomatic as well as symptomatic episodes. The measurement of atrial tachyarrhythmia burden is more practical now than in the past because of the availability of implantable devices capable of monitoring atrial tachyarrhythmia episodes. The advantage of burden over other endpoints is that it is not subject to investigator bias and it does not have the sampling error associated with episodic rhythm monitoring or the monitoring of patient symptoms. The use of burden as a surrogate endpoint for clinical outcome facilitates the demonstration of a biological effect of a therapy on the triggers or substrates responsible for the arrhythmia. Therapies that reduce burden can then be further studied to assess more traditional endpoints. A recent multicenter trial examined the effect of device-based atrial therapies on burden in patients receiving an implantable cardioverter defibrillator (Medtronic 7250 Jewel AF) to treat ventricular tachyarrhythmias. Patients were randomized to 3-month periods of atrial therapies \"ON\" or \"OFF\" and subsequently crossed over. The atrial therapies resulted in a reduction of atrial tachyarrhythmia burden from a mean of 58.5 hours/month to 7.8 hours/month (P = 0.007). Based on the evidence of a biological effect of the atrial therapies (burden reduction) studies to determine of the effects of AT/AF prevention and termination algorithms on morbidity and quality of life in ICD recipients are underway.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"355-8"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023138.85821.63","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24457690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical trials of prophylactic implantable defibrillator therapy in patients with nonischemic cardiomyopathy: what have we learned and what can we expect from future trials?","authors":"Wolfram Grimm","doi":"10.1023/B:CEPR.0000023152.66316.8f","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023152.66316.8f","url":null,"abstract":"<p><p>Several randomized clinical trials have been designed to evaluate the usefulness of prophylactic implantable cardioverter defibrillator (ICD) therapy in patients with nonischemic cardiomyopathy. In 2 trials, CAT and AMIOVIRT, no survival benefit was reported for patients with dilated cardiomyopathy and prophylactic ICD therapy. The major limitation of both trials is the small sample size of 104 patients in CAT and 103 patients in AMIOVIRT. Another limitation of both trials is the lack of a run-in phase on optimized medical therapy. Since LV function may improve considerably on optimized medical therapy, LV function should be reevaluated 3 to 4 months after initiation of ACE inhibitors, ss-blockers and aldosterone antagonists before prophylactic ICD therapy is considered. Two additional trials, DEFINITE and SCD-HEFT, are still ongoing. Particularly SCD-HEFT will follow a sufficient number of patients with nonischemic cardiomyopathy to give a more definitive answer with regard to the clinical usefulness of prophylactic ICDs in patients with nonischemic cardiomyopathy. Recently, the Marburg Cardiomyopathy study (MACAS) was finished. The results of MACAS strongly suggest that reduced LV ejection fraction is the most important arrhythmia risk predictor in idiopathic dilated cardiomyopathy, whereas signal-averaged ECG, baroreflex sensitivity, heart rate variability and T wave alternans do not appear to be helpful for arrhythmia risk stratification. In addition, MACAS showed that total mortality in patients with idiopathic dilated cardiomyopathy and an ejection fraction <30% is only about 5% per year on optimized medical therapy after exclusion of patients with end stage heart failure and after exclusion of patients with sustained ventricular arrhythmias. Thus, any future study designed to demonstrate a mortality benefit by prophylactic ICD therapy with an 80% power in this patient population needs to enroll more than 1000 patients.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"463-7"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023152.66316.8f","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24458081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial: The Future of Cardiac Electrophysiology Review","authors":"K. Anderson","doi":"10.1023/B:CEPR.0000023173.55306.66","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023173.55306.66","url":null,"abstract":"","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 1","pages":"311-311"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023173.55306.66","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57491366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transesophageal echocardiography to guide cardioversion in patients with atrial fibrillation: ACUTE trial update.","authors":"Craig R Asher,&nbsp;Allan L Klein","doi":"10.1023/B:CEPR.0000023146.37030.8c","DOIUrl":"https://doi.org/10.1023/B:CEPR.0000023146.37030.8c","url":null,"abstract":"<p><p>The Assessment of Cardioversion Using Transesophageal Echocardiography (ACUTE) trial was the first randomized prospective study to compare the conventional strategy of 3 weeks of anticoagulation before direct current cardioversion (DCC) for atrial fibrillation (AF) to a transesophageal echocardiography (TEE) guided approach with an expedited course of anticoagulation. This was a multicenter, international study with 70 sites enrolling 1222 patients between 1994-1999. The primary endpoint of composite embolic events and secondary endpoints including bleeding, functional status, prevalence of sinus rhythm, and death were assessed at 8 weeks following randomization. The ACUTE trial demonstrated that the TEE guided approach was safe and effective. There was no difference in the primary outcome of embolic events for the 2 strategies (0.8% TEE group vs. 0.5% conventional group, p =.50). There was a difference between the groups with respect to the number of bleeding events, with minor and major bleeding seen in 2.9% of patients in the TEE guided group and 5.5% in the conventional group (relative risk 0.53, 95% confidence interval 0.30-0.93, p = 0.03). The remaining secondary endpoints did not differ. Clinicians now have a viable alternative approach to cardioversion for patients with AF. Several factors influence the choice of strategies including (1) severity of symptoms and hemodynamic effect; (2) level and chronicity of anticoagulation; (3) risks of bleeding; (4) duration of AF and likelihood of reversion; and (5) risk and likelihood of left atrial thrombi. Future studies, such as ACUTE II are ongoing, with the aim of using low molecular weight heparin to further streamline the TEE guided approach to DCC and shorten hospital stay and costs.</p>","PeriodicalId":80888,"journal":{"name":"Cardiac electrophysiology review","volume":"7 4","pages":"387-91"},"PeriodicalIF":0.0,"publicationDate":"2003-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1023/B:CEPR.0000023146.37030.8c","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"24457034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}