Becky Lopez

Amiodarone in refractory life-threatening ventricular arrhythmias.

Ninety-six patients with life-threatening ventricular arrhythmias refractory to two or more conventional agents were treated with amiodarone and followed for 6 to 40 months (mean, 15 months). Currently, 75 are alive and well. Seven patients died from nonarrhythmic and five from arrhythmic causes. Nonfatal arrhythmias recurred in four patients, one with early and three with late onset. Intolerable side effects occurred in five patients but heart failure was not aggravated by the drug. On 24-hour Holter recordings done before and serially during therapy in 72 patients, amiodarone eliminated episodes of ventricular tachycardia and complex ectopy and reduced total ectopic beat counts by 90% or more in all but 4 patients. In contrast, ventricular tachycardia inducible by programmed electrical stimulation was suppressed in only 50% of patients, but failure of such suppression did not compromise an excellent clinical outcome. Thus, amiodarone is highly effective in the prophylaxis of recurrent refractory life-threatening ventricular arrhythmias.

Comparison of sotalol versus amiodarone in maintaining stability of sinus rhythm in patients with atrial fibrillation (Sotalol-Amiodarone Fibrillation Efficacy Trial [Safe-T])

The Sotalol-Amiodarone Fibrillation Efficacy Trial (SAFE-T) is a randomized, double-blind, multicenter, placebo-controlled trial in which the effects of sotalol and amiodarone in maintaining stability of sinus rhythm are being examined in patients with persistent atrial fibrillation at 20 Veterans Affairs medical centers. The time to the occurrence of atrial fibrillation or flutter in patients with atrial fibrillation converted to sinus rhythm is the primary outcome measure, with a number of parameters as secondary end points. SAFE-T had randomized 665 patients when enrollment terminated on October 31, 2001. Follow-up of patients continued until October 31, 2002, for a maximum period of 54 months and a minimum period of 12 months for all patients.

Felodipine Improves Left Ventricular Emptying in Patients With Chronic Heart Failure: V-HeFT III Echocardiographic Substudy of Multicenter Reproducibility and Detecting Functional Change

BACKGROUND The echocardiographic substudy of the Vasodilator-Heart Failure Trial III (V-HeFT III) aimed to determine if felodipine treatment in patients with heart failure who were taking an angiotensin-converting enzyme inhibitor had a favorable effect on left ventricular (LV) structure and function. Earlier V-HeFT trials showed that hydralazine-isosorbide dinitrate improved ejection fraction (EF) and survival, whereas enalapril achieved greater survival with smaller increases in EF. Would the combination of a potent vasodilator and enalapril produce greater improvements in function and survival? METHODS AND RESULTS Doppler-echocardiographic data were collected from 260 males with heart failure who were randomized to felodipine or a placebo. Mean intrasubject differences between baseline, at 3 months, and at 12 months were compared. Intersite and intrareader reproducibilities were measured from duplicate recordings and readings. At 3 months, no changes in ultrasound variables from baseline occurred in either group. At 12 months, felodipine patients achieved greater increases in EF, shortening of LV end-systolic length, and increases in stroke volume index. Reproducibility coefficients of variation were 7.4% (EF), 6.0% (end-diastolic length), and 13.0% (stroke volume index). CONCLUSIONS The echocardiographic substudy showed that felodipine, added to heart failure therapy, increased EF, shortened end-systolic length, and increased stroke volume index. The changes were small and confirmed that reproducibility from multiple laboratories can be coordinated into a useful research tool.

Atrial Fibrillation: Defining Some Unanswered Questions

news. Why are cardiologists focusing on an arrhythmia that was previously the domain of the internist and the generalist? Not so long ago, many physicians regarded AF as a relatively benign arrhythmia, which was often little worthy of serious scrutiny. For many years, attention and interest of cardiologists and the accelerating number of electrophysiologists have been directed sharply on the suppression of premature ventricular contractions and nonsustained ventricular tachycardia as markers of sudden death, and on symptomatic ventricular tachycardia (VT) and aborted cardiac arrests. The precise diagnosis and restoration and maintenance of sinus rhythm of various forms of re-entrant supraventricular tachycardias occupied a great deal of time for cardiologists and electrophysiologists. However, advances in these areas during the last 10 years have been nothing less than spectacular with radio-frequency ablation producing cure in the largest numbers of patients with supraventricular tachycardias (1).The combined use of beta-blockers and major antiarrhythmic drugs and implantable cardioverterdefibrillators has radically altered the approach to VT (2,3) and ventricular fibrillation along with radiofrequency ablation in different subsets of patients with life-threatening arrhythmias of ventricular origin (4). The therapeutic spotlight is now on AF. As an arrhythmia, AF is many times more common than sustained VT or fibrillation. Unlike the