The presence of angina before acute myocardial infarction seems to confer protection against in-hospital outcomes in adults; this effect seemed to be less obvious in elderly patients. This study suggests that the protection afforded by angina in adult patients may involve the occurrence of ischemic preconditioning, which seems to be lost in senescent patients.

ObjectivesTo describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.MethodsAn observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.ResultsThe study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3–10) days. The median length of stay was 9 (6–14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.ConclusionOur results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

Sinus tachycardia has been reported after radiofrequency catheter ablation of supraventricular tachycardia. Frequently, these patients require beta-blocking agents for symptomatic control. The purpose of this study was to evaluate prospectively the incidence of inappropriate sinus tachycardia and heart rate variability after ablation of atrioventricular nodal reentrant tachycardia and accessory pathways. Patients undergoing ablation had 24-h ambulatory monitoring ECG (Holter) performed before the procedure, on the day of the ablation, and 3 months afterwards. There were 170 patients, mean age 48 +/- 23 years; 93 were female. A complete study of the 24-h Holter with analysis of heart rate variability: SD, rMSSD, pNN50, high and low frequency was obtained. There was a low prevalence of inappropriate sinus tachycardia after the ablation procedure (10 of 170 patients: five with four atrioventricular nodal reentry, with posteroseptal accessory pathways and one of the latter following ablation of the left accessory pathway). There was no modification of time and frequency domain parameters of heart rate variability in the remaining patients who underwent radiofrequency ablation. Holter monitoring 3 months after ablation showed that parameters of heart rate and heart rate variability had normalized in patients who had developed inappropriate sinus tachycardia. Inappropriate sinus tachycardia may be initiated by both radiofrequency ablation of atrioventricular nodal reentrant tachycardia and radiofrequency ablation of posteroseptal accessory pathways. Specific damage to the posteroseptal region is responsible for these changes, which usually recover spontaneously after 3 months.

In this prospective, controlled and randomized cross-over study we tried to establish the efficiency and safety of flecainide vs procainamide for the treatment of acute atrial fibrillation. Eighty patients (30 females, 50 males, mean age: 55 +/- 14 years) were included. Patients entered into the study if they had atrial fibrillation of recent onset (< 24 h) with a ventricular rate > 100 beats.min-1 at rest and were < 75 years of age. Exclusion criteria were any sign of heart failure, conduction disturbances, sick sinus syndrome or acute ischaemic events. Randomly 40 patients received flecainide and 40 procainamide as the first treatment. There were no significant clinical difference between the two groups. Procainamide ws given at a dose of 1 g infused over 30 min, and followed by an infusion of 2 mg.min-1 over 1 h. Flecainide was given at a dose of 1.5 mg.kg-1 over 15 min followed by an infusion of 1.5 mg.kg-1 over 1 h. Drug infusion was continued until maximal dose, intolerance or reversion to sinus rhythm. After 1 h of wash out, patients remaining in atrial fibrillation were started on the second drug. Left atrial size was measured by echo. Serum levels of drug and atrial size did not differ between patients who returned to sinus rhythm and those who remained in atrial fibrillation. Conversion to sinus rhythm was achieved in 37 (92%) of the 40 patients treated with flecainide and 25 (65%) of those treated with procainamide (P < 0.001). The time required for reversion to sinus rhythm was similar between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Objectives We aimed to describe persistent symptoms and sequelae in patients with rheumatic and musculoskeletal diseases (RMD) after admission due to Covid-19, assessing the role of autoimmune rheumatic diseases (ARD) compared with and non-autoimmune rheumatic and musculoskeletal diseases (NARD) on persistent symptoms and sequelae. Methods We performed an observational study including RMD patients who attended a rheumatology clinic in Madrid that required admission due to Covid-19 (March to May 2020) and survived. The study began at discharge and ran until October 2020. Main outcomes were persistence of symptoms and sequelae related to Covid-19. The independent variable was the RMD group (ARD and NARD). Covariates included sociodemographics, clinical and treatment data. We ran a multivariate logistic regression model to assess the risk of the main outcomes by RMD group. Results We included 105 patients, of whom 51.5% had ARD and 68.57% reported at least 1 persistent symptom. Most frequent were dyspnea, fatigue, and chest pain. Sequelae were recorded in 31 patients. These included lung damage in 10.4% of patients, lymphopenia in 10%, a central retinal vein occlusion, and an optic neuritis. Two patients died. Eleven patients required readmission owing to Covid-19 problems (16.7% ARD vs 3.9% NARD; p = 0.053). No statistically significant differences were found between RMD groups in the final models. Conclusions Many RMD patients have persistent symptoms, as in other populations. Lung damage is the most frequent sequela. ARD compared with NARD does not seem to differ in terms of persistent symptoms or consequences, although ARD might have more readmissions due to Covid-19.