Evolocumab to reduce cardiovascular events: results of the (FOURIER) multinational trial

Journal of Community Hospital Internal Medicine Perspectives

Luu

Calestino

et al. 2018

Self Cite

The term ‘flutter’ and ‘fibrillation’ were first coined to differentiate the differences between fast, regular contractions in Atrial Flutter (AFLUT) with irregular, vermiform contractions of Atrial Fibrillation (AFIB). Management of these two diseases has been a challenge for physicians. Rate control (along with rhythm control) is the first line of management for symptomatic AFIB/AFLUT with Rapid Ventricular Rate (RVR). In some situations, atrial rhythms may not be well controlled by these anti-arrhythmic drugs, making cardioversion to sinus rhythm necessary. Anti-coagulation therapy in both the disease population is essential. Catheter ablation is an effective treatment option in certain patients that have AFIB/AFLUT refractory to medical management. Newer techniques like left atrial appendage (LAA) has been developed and is a highly attractive concept for the future in the management of AFIB/AFLUT. Newer novel drugs targeting specific ion channels are approaching the stages of clinical investigation. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain. This literature review serves as one of the guideline papers for current up-to-date management on both AFIB and AFLUT.

Section: Management and Treatmentmentioning

confidence: 99%

Section: Management and Treatmentmentioning

confidence: 99%

Management of atrial fibrillation-flutter: uptodate guideline paper on the current evidence

Journal of Community Hospital Internal Medicine Perspectives

Luu

Calestino

et al. 2018

Self Cite

“…He looked at 439 ARVC patients and 562 of their family members with median follow-up of 7 years [58,59]. SCD rate during the follow-up period was higher (16%) among patients without ICD placement compared to ARVC with ICD placement (0.6%).…”

Section: Cardiac Transplantationmentioning

confidence: 99%

“…SCD rate during the follow-up period was higher (16%) among patients without ICD placement compared to ARVC with ICD placement (0.6%). The study showed low mortality rate (6%) and low cardiac transplantation need (4%) among patients with ARVC [58,59]. In addition, the study showed that family members of ARVC with gene mutations were much more likely to develop symptomatic disease and die from a cardiac cause compared to family members without gene mutations.…”

Section: Cardiac Transplantationmentioning

confidence: 99%

Right ventricular dysplasia: management and treatment in light of current evidence

Idris

Journal of Community Hospital Internal Medicine Perspectives

Park

2018

Self Cite

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare cardiovascular disease that predisposes to ventricular arrhythmias potentially leading to sudden cardiac death (SCD). ARVC varies considerably with multiple clinical presentations, ranging from no symptoms to cardiac arrhythmias to SCD. ARVC prevalence is not well known, but the estimated prevalence in the general population is 1:5000. Diagnosis of ARVC can be made by using the Revised European Society of Cardiology criteria for ARVC that includes ventricular structural and functional changes, ECG abnormalities, arrhythmias, family and genetic factors. The management of ARVC is focused on prevention of lethal events such as SCD. Implantable cardioverter defibrillator placement is the only proven mortality benefit in treatment of ARVC. Other treatment strategies include medications such as beta blockers and antiarrhythmics, radiofrequency ablation, surgery, cardiac transplantation, and lifestyle changes. All these interventions help in symptomatic treatment but none of them have proved to decrease mortality rates. ARVC is a progressive disease that leads to SCD if not treated appropriately. Management of these diseases has been a challenge for physicians. With the advent of technology and many new drugs/devices under clinical investigation, this might change in the future. However, while advances in technologies have helped elucidate many aspects of these diseases, many mysteries still remain of this unique disease. With continued research, we can expect more cost-effective and patient-friendly drug therapies and ablation techniques to be developed in the near future.

“…This has been seen in various studies where catheter ablation was associated with positive outcomes in patients with HF [9–11]. Nevertheless, the clinical efficacy of catheter ablation in improving death or hospitalization rates has not yet been established in HF patients.…”

mentioning

confidence: 99%

Atrial fibrillation and heart failure- results of the CASTLE-AF trial

Journal of Community Hospital Internal Medicine Perspectives

Moosa

Fatima

et al. 2018

Self Cite

Congestive Heart Failure (HF) and Atrial Fibrillation (AFIB) often coexist. Catheter ablation is a well-established option for symptomatic AFIB that is resistant to drug therapy in patients with otherwise normal cardiac function. This has been seen in various studies where catheter ablation was associated with positive outcomes in patients with HF. Recently, the study results from the Catheter Ablation versus Standard Conventional Therapy in Patients with Left Ventricular Dysfunction and Atrial Fibrillation (CASTLE-AF) trial were published. After a median follow-up of more than 3 years, patients getting catheter ablation for AFIB had significantly fewer hospital admissions as well as death from worsening HF. In addition, 63% of patients in the ablation group were in sinus rhythm, as compared with 22% of those in the medical-therapy group (P < 0.001). This trial may represent a significant additional therapeutic tool in the clinical prevention and management of cardiovascular mortality and morbidity. While catheter ablation does not eliminate the AFIB per se, it can limit the ventricular rate by eliminating triggers and altering electrophysiological connections in the heart in a similar fashion to rate control anti-arrhythmic drugs. Longer-duration normal sinus rhythm may improve outcomes by means of a number of mechanisms, including greater atrial emptying, all of which translate into improved cardiac output. A better understanding is needed as to why a decrease in density, but not complete elimination of atrial fibrillation, is sufficient for reverse remodelling. It is anticipated that the results of the CASTLE-AF trial will soon be implemented in international guidelines.