Efficacy of Type 1C Antiarrhythmic Agents for Treatment of Resistant Atrial Fibrillation

In order to determine the efficacy of type lC agents (flecainide, encainide, propafenone) in patients with atrial fibrillation who have failed to maintain sinus rhythm with type 1A agents (quinidine, procainamide, disopyramide), 147 patients, that were admitted into the John Dempsey Hospital with new or recurrent atrial fibrillation between 1987–1991, were studied retrospectively. Out of the total, 29 patients converted spontaneously to sinus rhythm, 14 patients were left in atrial fibrillation, and 104 patients were given a type 1A antiarrhythmic. Sixty-five of these patients remained in sinus rhythm (54% converted on drug alone, 46% required electrical cardioversion) for at least 6 months. Of the remaining 39 patients, 28 were given a type 1C antiarrhythmic; 13 were successfully converted (61% chemical, 39% electrical) to and remained in sinus rhythm for at least 6 months; the remaining 15 either failed to convert or reverted to atrial fibrillation. New onset atrial fibrillation had a significantly lower incidence of congestive heart failure (10%) than recurrent atrial fibrillation (33%; P < 0.01). No differences in digoxin, beta blocker use, or other clinical characteristics were seen either between type 1A or type 1C successes or failures. Similarly, echocardiographic dimensions did not predict success or failure with either class of agent. In conclusion, type lC antiarrhythmics for suppression of recurrent atrial fibrillation represent a reasonable therapeutic alternative for suppression of atrial fibrillation in patients who have failed type lA agents. Prognostic factors predicting success or failure remain undetermined.     

EFFECTS OF AEROBIC CONDITIONING IN LUPUS FATIGUE: A PILOT STUDY

Fatigue, a complex symptom, significantly affects the qualityof life in many patients with systemic lupus erythematosus (SLE).To understand this phenomenon, 23 patients with SLE and fatiguewere studied. Standardized tests of depression (NIMH), fatigue,exercise tolerance (ETT) on a bicycle ergometer, and SLE activitywere obtained. At baseline, SLE patients had significantly lower maximum oxygenconsumption (Vbj max) than normals (p << 0.005). Adjustedfor age and sex, SLE patients perform at 54% of their expectedmaximum Vo₂, which is similar to published data from patientswith rheumatoid arthritis. Depression by NIMH was not correlatedwith Vo₂ max or length of time on ETT. Fatigue measured by Profileof Mood States (POMS) was correlated with ETT time (r = 0.476,p << 0.025) and with Vfoj max (r = –0.402, p <<0.07). After an 8-week aerobic conditioning programme the experimentalgroup increased their aerobic capacity by 19% in contrast to8% in controls. This change correlated with decreased fatigueas measured by visual analogue scales. Exercise did not exacerbatedisease, and only two of 16 experimental subjects experiencedtransient joint symptoms during exercise. KEY WORDS: Systemic lupus erythematosus, Depression, Mood, Oxygen consumption, Aerobic exercise, Fatigue     

Growth and Differentiation of Transplanted W/Wv Marrow

This paper reports new data on the effect of the action of the mutant genesW and W^v on murine hemopoiesis. Our studies demonstrate that the presenceof these mutant genes produces: (1) a macrocytic anemia with neithergranulocytopenia nor thrombocytopenia; (2) a severe defect in the earlystages of hemopoietic repopulation manifested by (a) an apparent block inthe differentiation of immature cells into erythroid precursors, and (b) a greatly reduced rate of proliferation of differentiated hemopoietic elements.

These data demonstrate the existence of genetic influence on repopulationand differentiation of transplanted marrow and suggest that severe anemia mayresult not only from defects in the late stages of erythroid development butalso from abnormalities in the early stages of erythroid maturation andhemopoietic repopulation.

Submitted on February 15, 1967 Accepted on May 5, 1967     

Access to Health‐Related Goods

There are many good reasons for a merger between bioethics and human rights. First, though, significant philosophical groundwork must be done to clarify what a human right to health would be and—if we accept that it exists—exactly how it might influence the practical decisions we face about who gets what in very different contexts.     

Low birth weight babies at 3 years of age

The findings of the first 3 years of a 7-year follow-up study on a group of 331 infants born at or transferred to Hammersmith and Queen Charlotte's Maternity Hospitals weighing 500-2000 g are reported. The group included 37 stillbirths, and a further 76 died. Of the 218 survivors, some information has been available on 215 (99%); 94% and 84% were seen at 2 and 3 years respectively. Nine (4%) children have major and 13 (6%) a moderate handicap, including 11 (5%) with cerebral palsy, seven (4%) with developmental delay, three with severe hearing impairment and one with visual impairment. Mild iatrogenic damage was common. The children, particularly those who were small for their gestational age, were shorter and lighter than the normal population at 3 years, but when corrected for prematurity the difference, particularly in height, was insignificant.