Sunday, October 31, 2010

The Power of One: a Highly Detailed, Log-Based, Case Example that Clearly Demonstrates the Effective Use of Ranolazine for the Control of Progressive


Citation : James A. Reiffel.The Power of One: a Highly Detailed, Log-Based, Case Example that Clearly Demonstrates the Effective Use of Ranolazine for the Control of Progressive Atrial Fibrillation. .JAFIB.2010 October;Volume 2 Issue(2): 810-813.

This manuscript is a case report documented by a detailed patient log, that demonstrates efficacy of ranolazine for the management of paroxysmal atrial fibrillation that was progressive and resistant to prior antiarrhythmic drug therapy.

Ablation of Longstanding Persistent Atrial Fibrillation


Citation : Edward J. Ciaccio.Ablation of Longstanding Persistent Atrial Fibrillation .JAFIB.2010 October;Volume 2 Issue(2): 806-809.

To prevent recurrence of paroxysmal atrial fibrillation (AF, events < 7 days) isolation of pulmonary vein (PV) triggers results in success rates of up to 0.9 (i.e. 90%). Recent evidence suggests that complete circumferential antral ablation is not even necessary for PV isolation. When AF persists beyond one week, electrical and anatomic substrate remodeling typically occurs. Initially, when remodeling is slight, the arrhythmia can be terminated by PV isolation with only a few left atrial ablation lesions required in addition. However if longstanding persistent atrial fibrillation is present (defined as event duration > 6 months4 or > 1 year) greater left atrial substrate modification is necessary

Commentary on: Pericardial Fat is Independently Associated with Human Atrial Fibrillation by Al Chekakie et al.


Citation : Omar Batal,Mina K. Chung.Commentary on: Pericardial Fat is Independently Associated with Human Atrial Fibrillation by Al Chekakie et al. .JAFIB.2010 October;Volume 2 Issue(2): 803-805.

Obesity is an established risk factor for atrial fibrillation (AF). In fact, it has been reported that the increasing prevalence of obesity in the United States could account for up to 60 % of the increasing incidence of age and sex adjusted AF. Adipose tissue has been shown to be highly metabolically active and secretes several proinflammatory mediators; however, different fat depots differ in metabolic and inflammatory activity.

Left Atrial Appendage: Extending the Search for New Sources of Atrial Fibrillation Triggers


Citation : Yoshihide Takahashi.Left Atrial Appendage: Extending the Search for New Sources of Atrial Fibrillation Triggers .JAFIB.2010 October;Volume 2 Issue(2): 802.

The discovery of the role of the pulmonary veins (PVs) in atrial fibrillation (AF) has facilitated us to perform an anatomy-based ablation, “PV isolation”. Although several new mapping technologies have been developed, activation mapping during ongoing AF is still challenging. To improve the efficacy of AF ablation, therefore, we attempted to find the second “hot spot”. The superior vena cava, ligament of Marshall, coronary sinus and posterior LA have been reported as second critical areas for AF ablation. However, there remain patients who are refractory to catheter ablation targeting all of those above areas.

Stroke Prevention in Atrial Fibrillation


Citation : Tatjana Rundek, Sebastian Koch, Michael Katsnelson.Stroke Prevention in Atrial Fibrillation .JAFIB.2010 October;Volume 2 Issue(2): 790-801.

Non-valvular atrial fibrillation has been shown to be the most common cardiac arrhythmia with a growing world-wide incidence and a profound, better understood associated morbidity and mortality, most notably with cardioembolic strokes. This brief review highlights the risk of stroke and important studies of the latest treatment modalities available for stroke prevention in patients with non-valvular atrial fibrillation.

Management of Atrial Fibrillation in Pregnancy


Citation : Luca Cacciotti, Ilaria Passaseo.Management of Atrial Fibrillation in Pregnancy .JAFIB.2010 October;Volume 2 Issue(2): 785-789.

Pregnancy is accompanied by a variety of cardiovascular changes in normal women; all of these changes are thought to promote arrhythmogenesis. Atrial fibrillation is unusual during pregnancy and it can represent a benign, self-limited lone atrial fibrillation or can be hemodynamically significant in parturient with or without structural heart disease. Management of atrial fibrillation should be the same as in non-pregnant women, but requires faster intervention, even in patients with a normal heart function, and cautious use of medication to avoid harm to the fetus. We might remember that synchronized electrical cardioversion has been performed safely during all stages of pregnancy.

Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation


Citation :
Stavros Mountantonakis, Edward P.Gerstenfeld.Atrial Tachycardias Occurring After Atrial Fibrillation Ablation: Strategies for Mapping and Ablation .JAFIB.2010 October;Volume 2 Issue(2): 770-784.

The occurrence of left atrial tachycardias (AT) after catheter ablation for atrial fibrillation (AF) are common, especially after more extensive ablation of persistent AF. These AT are invariably symptomatic and often do not respond to medical therapy. The initial strategy involves ventricular rate control, cardioversion, and observation as some tachycardias may resolve with time. For persistent ATs, effective management frequently requires catheter intervention. Careful characterization of the tachycardia mechanism is essential in designing an effective ablation strategy that would also avoid further creation of pro-arrhythmic substrate. With this review, we summarize the incidence, mechanism, diagnosis and treatment of ATs occurring after AF ablation.

Endurance Sport Practice and Atrial Fibrillation


Citation : Lluis Mont, Naiara Calvo.Endurance Sport Practice and Atrial Fibrillation .JAFIB.2010 October;Volume 2 Issue(2): 762-769.

Atrial fibrillation (AF) is the most common cardiac rhythm disorder in clinical practice, with an estimated prevalence of 0.4% to 1% in the general population, increasing with age to 8% in those older than 80 years. The recognized risk factors for developing AF include age, hypertension, structural heart disease, diabetes mellitus, and hyperthyroidism. However, the etiology remains unclear in a significant number of patients younger than age 60 in whom no cardiovascular disease or any other known causal factor is present. This condition is termed lone AF, and may be responsible for as many as 30% of patients with paroxysmal AF seeking medical attention. Although regular physical activity clearly reduces cardiovascular morbidity risk, in recent years long-term endurance sport practice has been recognized as a risk factor for AF. However, the underlying mechanism explaining this association is unclear.

Angiotensin Receptor Blockers for the Prevention of Atrial Fibrillation Recurrences: Unending Hot Debate


Citation : Turgay Celik.Angiotensin Receptor Blockers for the Prevention of Atrial Fibrillation Recurrences: Unending Hot Debate .JAFIB.2010 October;Volume 2 Issue(2): 760-761.

Although there is a plausible scientific basis for the notion that inhibition of the renin-angiotensin system can reduce the incidence of atrial fibrillation (AF) the greatest benefit was seen in patients with heart failure/left ventricular dysfunction in whom therapy with an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blockers (ARBs) is probably already indicated. A number of initial studies suggested that ACE inhibitors and ARBs might prevent new onset and recurrent AF. However, the available data do not support the use of these drugs solely for the prevention of AF. I believe that additional prospective definitive trials are needed to clarify the role of ARBs in the prevention of AF recurrence.

Effect of High-dose Telmisartan on the Prevention of Recurrent Atrial Fibrillation in Hypertensive Patients


Citation : Shingo Maeda, Mitsuhiro Nishizaki, Noriyoshi Yamawake, Takashi Ashikaga, Kensuke Ihara, Tadashi Murai, Hiroyuki Fujii, Harumizu Sakurada, Masayasu Hiraoka, Mitsuaki Isobe.Effect of High-dose Telmisartan on the Prevention of Recurrent Atrial Fibrillation in Hypertensive Patients .JAFIB.2010 October;Volume 2 Issue(2): 747-759.

Background: Telmisartan has been shown to exert an equivalent action as ramipril on the prevention of cardiovascular events, but the dose-dependent actions of telmisartan on the prevention of events remain unknown.

Objective: We investigated the dose-dependent effects of telmisartan on the prevention of AF in patients associated with risk factors.

Methods: One hundred hypertensive patients were randomized to take 40 mg (low-dose group: n=57) or 80 mg (high-dose group: n=43) of telmisartan for 24 months. The primary endpoints were defined as a new development and/or recurrence of atrial fibrillation (AF).

Results: The mean values of the blood pressure in both groups decreased significantly and to similar degrees after 24 months, in the low-dose (p < 0.01) and high-dose (p < 0.01) groups. At the end of the follow-up, the incidence of AF was lower in the high-dose group than in the low-dose group (p < 0.05). Moreover, the proportion of AF recurrences in the patients with a past history of paroxysmal AF was lower in the high-dose group than in the low-dose group (p < 0.05). Further, using a logistic regression model, there were no risk factors associated with the incidence of AF.

Conclusion: The results indicated that telmisartan in low doses was as effective in controlling the blood pressure as in high doses, but high doses of telmisartan had beneficial effects on preventing the recurrence of AF in hypertensive patients.