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cardiac arrhythmia suppression trial

David Charles Hutchings, Simon George Anderson, Jessica L Caldwell, Andrew W Trafford
Novel cardioprotective agents are needed in both heart failure (HF) and myocardial infarction. Increasing evidence from cellular studies and animal models indicate protective effects of phosphodiesterase-5 (PDE5) inhibitors, drugs usually reserved as treatments of erectile dysfunction and pulmonary arterial hypertension. PDE5 inhibitors have been shown to improve contractile function in systolic HF, regress left ventricular hypertrophy, reduce myocardial infarct size and suppress ischaemia-induced ventricular arrhythmias...
March 8, 2018: Heart: Official Journal of the British Cardiac Society
Annette Witt, Frithjof Ehlers, Stefan Luther
We have analyzed symbol sequences of heart beat annotations obtained from 24-h electrocardiogram recordings of 184 post-infarction patients (from the Cardiac Arrhythmia Suppression Trial database, CAST). In the symbol sequences, each heart beat was coded as an arrhythmic or as a normal beat. The symbol sequences were analyzed with a model-based approach which relies on two-parametric peaks over the threshold (POT) model, interpreting each premature ventricular contraction (PVC) as an extreme event. For the POT model, we explored (i) the Shannon entropy which was estimated in terms of the Lempel-Ziv complexity, (ii) the shape parameter of the Weibull distribution that best fits the PVC return times, and (iii) the strength of long-range correlations quantified by detrended fluctuation analysis (DFA) for the two-dimensional parameter space...
September 2017: Chaos
Xi Wang, Dan Hu, Song Dang, He Huang, Cong-Xin Huang, Ming-Jie Yuan, Yan-Hong Tang, Qing-Shan Zheng, Fang Yin, Shu Zhang, Bo-Li Zhang, Run-Lin Gao
BACKGROUND: Pharmacological therapy for congestive heart failure (CHF) with ventricular arrhythmia is limited. In the study, our aim was to evaluate the effects of Chinese traditional medicine Shensong Yangxin capsules (SSYX) on heart rhythm and function in CHF patients with frequent ventricular premature complexes (VPCs). METHODS: This double-blind, placebo-controlled, multicenter study randomized 465 CHF patients with frequent VPCs to the SSYX (n = 232) and placebo groups (n = 233) for 12 weeks of treatment...
July 20, 2017: Chinese Medical Journal
A John Camm
Ventricular arrhythmias such as sustained ventricular tachycardia and ventricular fibrillation account for two thirds of sudden cardiac deaths. Most ventricular tachyarrhythmias have well understood mechanisms such that it is theoretically possible to conceive of an antiarrhythmic drug-based intervention that would prevent arrhythmias that cause sudden cardiac death. Pharmaceutical agents which interfere with ion channel activity are known as antiarrhythmic drugs. Acute experiments showing antiarrhythmic effects in the basic science laboratory have often not translated into clinical effectiveness...
June 15, 2017: International Journal of Cardiology
Jaber Abboud, Joachim R Ehrlich
Implantable cardioverter defibrillators (ICDs) are effective in the prevention of arrhythmic sudden cardiac death. Many patients receiving an ICD are affected by heart failure and are at risk of ventricular arrhythmias, which may lead to appropriate shocks. On the other hand, in this population the incidence of atrial fibrillation, giving rise to inappropriate ICD shocks, is high. Accordingly, ICD discharges occur frequently and many patients with an ICD will need concomitant antiarrhythmic drug therapy to avoid or reduce the frequency of shocks...
August 2016: Arrhythmia & Electrophysiology Review
Deepanwita Das, Chaitali Sen, Anupam Goswami
INTRODUCTION: Etomidate is usually preferred in the induction of cardiac compromised patients due to its relative cardiovascular stability. However, the use of this drug has been limited as etomidate induces suppression of cortisol biosynthesis as a result of blockade of 11-beta-hydroxylation in the adrenal gland, mediated by the imidazole radical of etomidate. This study was carried out to observe the effect of Vitamin C on adrenal suppression after etomidate induction in patients undergoing cardiac surgery...
July 2016: Annals of Cardiac Anaesthesia
Mohammad Shenasa, Hamid Assadi, Shahriar Heidary, Hossein Shenasa
Ranolazine is currently approved as an antianginal agent in patients with chronic angina (class IIA). Ranolazine exhibits antiarrhythmic effects that are related to its multichannel blocking effect, predominantly inhibition of late sodium (late INa) current and the rapid potassium rectifier current (IKr), as well as ICa, late ICa, and INa-Ca. It also suppresses the early and delayed after depolarizations. Ranolazine is effective in the suppression of atrial and ventricular arrhythmias (off-label use) without significant proarrhythmic effect...
June 2016: Cardiac Electrophysiology Clinics
J Kuschyk, B Rudic, I Akin, M Borggrefe, S Röger
INTRODUCTION: In the last few decades, defibrillator therapy has revolutionized treatment of patients at risk for sudden cardiac death. Multiple clinical trials have shown the benefit of implantable cardioverter-defibrillators (ICD) for primary and secondary prevention of sudden cardiac death. Being an entirely subcutaneous system, the S-ICD® avoids important periprocedural and long-term complications associated with transvenous implantable cardioverter-defibrillator (TV-ICD) systems as well as the need for fluoroscopy during implant surgery...
June 2015: Herzschrittmachertherapie & Elektrophysiologie
Dawood Darbar
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide requiring therapy. Despite recent advances in catheter-based and surgical therapy, antiarrhythmic drugs (AADs) remain the mainstay of treatment for symptomatic AF. However, response in individual patients is highly variable with over half the patients treated with rhythm control therapy experiencing recurrence of AF within a year. Contemporary AADs used to suppress AF are incompletely and unpredictably effective and associated with significant risks of proarrhythmia and noncardiac toxicities...
January 2016: Journal of Cardiovascular Pharmacology
George K Andrikopoulos, Sokratis Pastromas, Stylianos Tzeis
Flecainide acetate is a class IC antiarrhythmic agent and its clinical efficacy has been confirmed by the results of several clinical trials. Nowadays, flecainide is recommended as one of the first line therapies for pharmacological conversion as well as maintenance of sinus rhythm in patients with atrial fibrillation and/or supraventricular tachycardias. Based on the Cardiac Arrhythmia Suppression Trial study results, flecainide is not recommended in patients with structural heart disease due to high proarrhythmic risk...
February 26, 2015: World Journal of Cardiology
Yoko M Nakao, Kenji Ueshima, Shinji Yasuno, Shigetake Sasayama
It was previously reported that nocturnal home oxygen therapy (HOT) significantly improved not only sleep disordered breathing (SDB), but also quality of life (QOL) and left ventricular ejection fraction (LVEF) in two trials. To strengthen the statistical reliability of the above efficacies of HOT and to assess the effects of 12-week nocturnal HOT on suppression of ventricular arrhythmias, we combined the two trials and undertook a post hoc analysis. Ninety-seven patients with chronic heart failure (CHF) and central sleep apnea were assigned to receive HOT (45 patients) or not (52 patients)...
February 2016: Heart and Vessels
Kristen K Patton, Anne S Hellkamp, Kerry L Lee, Daniel B Mark, George W Johnson, Jill Anderson, Gust H Bardy, Jeanne E Poole
OBJECTIVES: This study sought to determine whether circadian patterns in ventricular arrhythmias (VAs) occur in a current primary prevention defibrillator (implantable cardioverter-defibrillator [ICD]) population. BACKGROUND: Cardiovascular events, including VAs, demonstrate biorhythmic periodicity. METHODS: We tested for deviation from the previously described occurrences of a morning peak, early morning nadir, and peak on Mondays in ICD therapies using generalized estimating equations and Student t tests...
June 24, 2014: Journal of the American College of Cardiology
Farah Z Dawood, Mollie P Roediger, Greg Grandits, Dery Miller, Martin Fisher, Zhu-Ming Zhang, Sally Hodder, Jennifer F Hoy, Jens D Lundgren, James D Neaton, Elsayed Z Soliman
BACKGROUND: A widened electrocardiographic spatial QRS-T angle has been shown to be predictive of cardiovascular disease in HIV-infected individuals. However, determinants and risk factors of developing widened QRS-T angle over time in this population remain unknown. METHODS AND RESULTS: Spatial QRS-T angle was automatically measured from standard electrocardiogram of 1444 HIV-infected individuals without baseline widened spatial QRS-T angle from the Strategies for Management of Antiretroviral Therapy [SMART], a clinical trial comparing two antiretroviral treatment strategies [Drug Conservation (DC) vs...
March 2014: Journal of Electrocardiology
Muli Wu, Zheng Huang, Haojun Xie, Zhongjiang Zhou
BACKGROUND: Nicorandil, as an adjunctive therapy with primary percutaneous coronary intervention (PCI), had controversial benefits in cardioprotection in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: We performed a systematic review of randomized controlled trials (RCTs) comparing treatment with nicorandil prior to reperfusion therapy with control (placebo or no nicorandil) in patients who suffered from AMI and performed primary PCI. PubMed, EMBASE and CENTRAL databases and other sources were searched without language and publication restriction...
2013: PloS One
(no author information available yet)
The cornerstones of treatment for obesity, and even more so for simple overweight, are dietary measures and physical exercise. There are no drugs with a favourable harm-benefit balance in this setting. A fixed-dose combination of topiramate, an antiepileptic drug, and phentermine, an appetite-suppressant amphetamine, has been refused marketing authorisation in the European Union, after being licensed in the United States. There are no randomised controlled trials of topiramate + phentermine in the prevention of complications of obesity...
March 2013: Prescrire International
Stavros Apostolakis, Michael Oeff, Ulrich Tebbe, Larissa Fabritz, Günter Breithardt, Paulus Kirchhof
INTRODUCTION: Flecainide is a class Ic antiarrhythmic agent available in Europe since 1982. The clinical development program of flecainide provided good data on its antiarrhythmic effect for the prevention of ventricular and supraventricular arrhythmias. The Cardiac Arrhythmia Suppression Trial (CAST), conducted to test whether the arrhythmia suppression translates into prevention of sudden death, assessed the impact of flecainide and encainide therapy in patients with frequent ventricular ectopics and reduced left ventricular function who had survived an infarction...
February 2013: Expert Opinion on Pharmacotherapy
Antonio Molina-Picó, David Cuesta-Frau, Pau Miró-Martínez, Sandra Oltra-Crespo, Mateo Aboy
Signal entropy measures such as approximate entropy (ApEn) and sample entropy (SampEn) are widely used in heart rate variability (HRV) analysis and biomedical research. In this article, we analyze the influence of QRS detection errors on HRV results based on signal entropy measures. Specifically, we study the influence that QRS detection errors have on the discrimination power of ApEn and SampEn using the cardiac arrhythmia suppression trial (CAST) database. The experiments assessed the discrimination capability of ApEn and SampEn under different levels of QRS detection errors...
April 2013: Computer Methods and Programs in Biomedicine
Dale C Hesdorffer, Torbjorn Tomson
Among people with epilepsy, there is a 20-fold higher risk of dying suddenly and unexpectedly compared with the general population. This phenomenon is called sudden unexpected death in epilepsy (SUDEP) and the term is used when sudden death occurs in an otherwise reasonably healthy person with epilepsy and the autopsy is unrevealing. In most cases, SUDEP occurs during sleep and is unwitnessed. Risk factors for SUDEP include the presence or number of generalized tonic-clonic seizures (GTCS), nocturnal seizures, young age at epilepsy onset, longer duration of epilepsy, dementia, absence of cerebrovascular disease, asthma, male gender, symptomatic aetiology of epilepsy and alcohol abuse...
February 2013: CNS Drugs
Manoj N Obeyesekere, Raymond W Sy, Peter Leong-Sit, Lorne J Gula, Raymond Yee, Allan C Skanes, George J Klein, Andrew D Krahn
Catecholaminergic polymorphic ventricular tachycardia is a rare genetic disorder caused by mutations in genes involved in the intracellular calcium homeostasis of cardiac cells. Affected patients typically present with life-threatening ventricular arrhythmias precipitated by emotional/physical stress. The diagnosis is based on the demonstration of polymorphic or bidirectional ventricular tachycardia associated with adrenergic stress. Genetic testing can be confirmatory in some patients. Treatment for catecholaminergic polymorphic ventricular tachycardia includes medical and surgical efforts to suppress the effects of epinephrine at the myocardial level and/or modulation of calcium homeostasis...
May 2012: Future Cardiology
David Adams, Didier Samuel, Michel Slama
The treatment of familial amyloid polyneuropathies (FAP) is complex and requires a neurological and cardiological multidisciplinary coverage. It includes specific treatments to control the progression of the systemic amyloidogenesis, the symptomatic treatment of the peripheral and autonomic neuropathy (digestive, urinary, sexual, postural hypotension) and the treatment of organs severely involved by amyloidosis (heart, eyes, kidneys). First line specific treatment of met30 TTR-FAP is liver transplantation (LT) which allows to suppress the main source of mutant TTR, to stop the progression of the neuropathy in 70 % of cases at long-term (with an experience of 18 years) and to double the median survival...
September 2012: La Presse Médicale
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