{"title":"Quality of Life in Atrial Fibrillation: Rhythm or Rate Control","authors":"M. D. Engelmann, S. Pehrson","doi":"10.1159/000075710","DOIUrl":"https://doi.org/10.1159/000075710","url":null,"abstract":"Accessible online at: www.karger.com/hed The management of atrial fibrillation may be based either on rate control or rhythm control. Four recent randomized clinical trials have been undertaken to compare the benefits and risks of the two approaches [1–4], and none of the studies reported any advantage for the rhythm control strategy. On the basis of these data, numerous editorials [5, 6] have concluded that rate control can be considered the primary approach for the majority of patients with atrial fibrillation. This may be the pragmatic approach in clinical practice in the elderly mildly symptomatic patient with persistent atrial fibrillation. However, more data are needed on groups of patients and therapies underrepresented in these trials. Only a minority had extensive structural heart disease, and highly symptomatic patients were not enrolled. Furthermore, only three studies have compared quality of life (QoL), and only one study has used more than one QoL instrument. In the studies by Hohnloser et al. [1] and Van Gelder et al. [2], QoL was assessed by a single generic instrument, and differences in important disease-specific dimensions (atrial-fibrillation-related symptoms) may have been overlooked. In all studies, QoL was significantly impaired compared to a general population of similar age [1–3]. Improvements in QoL were noted in both treatment strategies [1, 3], whereas only minor changes were observed in the study by Hagens et al. [7]. There were no significant differences between the two treatment strategies in any of the studies. It is noteworthy that in these mildly symptomatic patients, who seemingly had a small burden of cardiac disease, QoL was impaired even after pharmacological treatment. These results can be readily compared with nonpharmacologic treatment strategies where patients burdened by severe symptoms caused by atrial fibrillation report enhanced QoL [8], and in some cases even normative levels are reached after nonpharmacologic intervention [9]. Comparing the rate versus rhythm control approach, the impact of the pharmacological treatment strategies on QoL is in other words suboptimal and it may be argued that a greater use of nonpharmacologic therapies might have produced more favorable results with respect to the rhythm control strategy. The negative impact of atrial fibrillation on QoL should be evaluated in the context of other known hemodynamic and structural effects that have been described as a consequence of atrial fibrillation, i.e. loss of the atrial contribution to ventricular filling, irregularity in ventricular response leading to hemodynamic impairment and the risk of tachycardia-mediated cardiomyopathy. From this perspective, the rate control approach appears as a temporary strategy in the elderly mildly symptomatic patient with persistent atrial fibrillation. The ultimate goal for all patients with atrial fibrillation is still the maintenance of sinus rhythm, and the results from the above-mentioned fo","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"24 1","pages":"236 - 236"},"PeriodicalIF":0.0,"publicationDate":"2004-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000075710","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65205828","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}
E. Kaluski, Monika Shah, I. Kobrin, Z. Vered, G. Cotter
{"title":"Right Heart Catheterization: Indications, Technique, Safety, Measurements, and Alternatives","authors":"E. Kaluski, Monika Shah, I. Kobrin, Z. Vered, G. Cotter","doi":"10.1159/000075709","DOIUrl":"https://doi.org/10.1159/000075709","url":null,"abstract":"For over three decades, balloon-tipped right heart catheterization (RHCn) has been employed to assist in the diagnosis, assessment, and management of high-risk patients and interventions. There has been a considerable debate regarding the safety and efficacy of this clinical tool, and even moratorium has been suggested. Currently, even in the face of contemporary noninvasive methods to obtain hemodynamic data, RHCn is still utilized. However, quality randomized clinical trials, assessing the effects RHCn on outcome of well-defined patient’s subsets, are clearly lacking. The contemporary indications, technique, and safety issues are discussed. Accurate data acquisition and interpretation are emphasized. Finally, RHC data are compared with hemodynamic information obtained noninvasively by impedance cardiography (ICG), and echocardiograpy and Doppler analysis. Recently, modern pump-function descriptor (cardiac power) derived from cardiac output measurements have emerged. The important interplay between the systemic and pulmonary circulation became increasingly acknowledged. Although modern right heart catheters (RHCs) are able to provide comprehensive, continuous, real-time, and effort-free hemodynamic data, they did not replace the 30-year-old inexpensive RHCs. Regrettably, no noninvasive alternatives can provide all these features. Our educational goals should include more appropriate case selection, along with safer insertion and reliable data acquisition and interpretation. The industry should attempt to incorporate into the monitored intensive care bed, safer systems and devices that provide continuous, ‘hands-off’, low maintenance, comprehensive and accurate hemodynamic data. RHCn is still an excellent and most comprehensive clinical and research method for hemodynamic assessment and monitoring. It is likely to continue to play a pivotal role in modern intensive care as well as contemporary research. In clinical practice, case selection for RHCn should be based on the clinical questions and dilemmas the patient is presenting. In research, RHCn should be employed whenever noninvasive methods could not reliably obtain data that are required to answer the scientific question.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"3 1","pages":"225 - 235"},"PeriodicalIF":0.0,"publicationDate":"2004-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000075709","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65205636","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}
T. Nagasaka, T. Kaneko, A. Nakao, T. Tokoro, E. Tezel, R. Sutton, D. Criddle, M. Raraty, A. Tepikin, J. Neoptolemos, O. Petersen, M. Singer, L. Cosen-Binker, M. Binker, R. Charnley, David R. Fine, O. Tiscornia, G. Negri, J. Cunha, M. Perini, S. Siqueira, J. Jukemura, S. Penteado, M. Machado, E. Abdo, A. Montagnini, S. Mettu, J. Wig, M. Khullar, Gurpreet Singh, Rajesh Gupta, A. Yu, D. Riegert-Johnson, A. Andrén-sandberg
{"title":"Contents Vol. 3, 2003","authors":"T. Nagasaka, T. Kaneko, A. Nakao, T. Tokoro, E. Tezel, R. Sutton, D. Criddle, M. Raraty, A. Tepikin, J. Neoptolemos, O. Petersen, M. Singer, L. Cosen-Binker, M. Binker, R. Charnley, David R. Fine, O. Tiscornia, G. Negri, J. Cunha, M. Perini, S. Siqueira, J. Jukemura, S. Penteado, M. Machado, E. Abdo, A. Montagnini, S. Mettu, J. Wig, M. Khullar, Gurpreet Singh, Rajesh Gupta, A. Yu, D. Riegert-Johnson, A. Andrén-sandberg","doi":"10.1159/000076735","DOIUrl":"https://doi.org/10.1159/000076735","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"3 1","pages":"241 - 242"},"PeriodicalIF":0.0,"publicationDate":"2004-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000076735","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65216137","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}
M. D. Engelmann, S. Pehrson, U. Keller, E. Kaluski, Monika Shah, I. Kobrin, Z. Vered, G. Cotter, F. Liistro, L. Bolognese, B. Nilsson, Xu Chen, J. Svendsen, A. Goette, U. Lendeckel, Sara Mobasseri, P. Liebson, L. Klein, P. Benes
{"title":"Subject Index Vol. 3, 2003","authors":"M. D. Engelmann, S. Pehrson, U. Keller, E. Kaluski, Monika Shah, I. Kobrin, Z. Vered, G. Cotter, F. Liistro, L. Bolognese, B. Nilsson, Xu Chen, J. Svendsen, A. Goette, U. Lendeckel, Sara Mobasseri, P. Liebson, L. Klein, P. Benes","doi":"10.1159/000076734","DOIUrl":"https://doi.org/10.1159/000076734","url":null,"abstract":"","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"3 1","pages":"240 - 240"},"PeriodicalIF":0.0,"publicationDate":"2004-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000076734","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65216034","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":"Drug-Eluting Stents","authors":"F. Liistro, L. Bolognese","doi":"10.1159/000075706","DOIUrl":"https://doi.org/10.1159/000075706","url":null,"abstract":"Although coronary stenting improves angiographic and clinical outcome of patients with coronary stenosis compared to balloon angioplasty, in-stent restenosis (ISR) still represents a major limitation of this approach. In the last decades several attempts have been made to lower ISR occurrence but most of the strategies adopted failed to demonstrate any benefit. Recently, the concept of using stents coated with agents that could potentially inhibit restenosis has emerged and drug-eluting stents (DES) represent one of the fastest growing fields in interventional cardiology today. The article reviews the progress of the DES concept and the results of the major clinical trials evaluating the impact of DES on restenosis.","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"3 1","pages":"203 - 213"},"PeriodicalIF":0.0,"publicationDate":"2004-02-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000075706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65205487","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":"Regulation of Hemostasis by the Sympathetic Nervous System: Any Contribution to Coronary Artery Disease?","authors":"Daniel Preckel, Roland von Känel","doi":"10.1159/000078415","DOIUrl":"https://doi.org/10.1159/000078415","url":null,"abstract":"<p><p>Within the last two decades, hemostasis factors have emerged as 'new' risk factors for coronary artery disease. Historical studies on the physiology of the sympathetic nervous system (SNS) attributed accelerated blood clotting to the components of the fight-flight response. Although this has not been demonstrated, exaggerated clotting related to SNS hyperactivity might confer an increased arterial thrombotic risk. This review outlines the effects of sympathetic activation as mimicked by adrenergic infusions and as elicited by mental stress and physical exercise, and the molecular mechanisms involved. A selective review of the pertinent literature was undertaken. Sympathetic activation provokes a simultaneous increase in molecules of both the coagulation and fibrinolysis pathways within minutes, resulting in net hypercoagulability as a part of normal human physiology. Catecholamines and adrenergic receptors interact to mediate hemostatic changes. Exaggerated procoagulant changes in individuals with a preexistent atherosclerotic disease, in those experiencing ongoing stressful life circumstances and in the physically untrained might confer a thrombotic threat with sympathetic activation. Initial evidence suggests that nonselective β-adrenergic blockade may attenuate clotting acceleration upon SNS activation. Prospective studies are needed to demonstrate whether exaggerated clotting as elicited by the SNS is associated with an increased risk of cardiovascular morbidity and mortality. If confirmed, intervention studies targeted at reducing this risk, for example with drugs, psychotherapy (including stress management) and regular physical exercise, would be warranted.</p>","PeriodicalId":87985,"journal":{"name":"Heartdrug : excellence in cardiovascular trials","volume":"4 3","pages":"123-130"},"PeriodicalIF":0.0,"publicationDate":"2004-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1159/000078415","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"27945977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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