High Energy Transcatheter Cardioversion for Chronic, Poorly Tolerated Atrial Fibrillation

Between August 1991 and May 1993, 14 patients affected by chronic, poorly tolerated atrial fibrillation (AF) were submitted to high energy transcatheter Cardioversion. Mean duration of AF was 27.4 ± 45.1 months. In nine patients (56%), AF lasted for > 1 year. All patients had underlying heart disease, with a mean LVEF of 45.2%± 11.8% and a NYHA Class ≥ II. Previously, a mean of 2.9 ± 1.3 patients failed external electrical Cardioversion, with and without antiarrhythmics, have been attempted. Transcatheter conversion was performed by pulling the His-bundle catheter back in the right atrial cavity until no His bundle activity was recorded on distal poles, and then delivering the shock between a proximal electrode (cathode) and a back plate (anode). In all patients, transcatheter conversion restored sinus rhythm. Transient complete atrioventricular (AV) block was observed in four patients (28%), and treated by prophylactic temporary pacing. At 1 year, seven patients (50%) were still in sinus rhythm. In this series, only younger age could be related to AF recurrence (46.1 ± 10.8 vs 63.4 ± 6.8 years, P ≤ 0.004), even if prophylaxis with amiodarone showed a positive trend versus sinus rhythm maintenance (71 % vs 14%, P = NS). In conclusion, high energy transcatheter Cardioversion is a safe and effective method of restoring sinus rhythm in patients with chronic, poorly tolerated AF. In these patients, high energy transcatheter Cardioversion could be considered as an alternative to AV node ablation techniques, avoiding pacemaker implant and embolic risk. Larger studies are needed to determine better patient selection and delineate drug strategy after the procedure.     

The VITA Project: C677T mutation in the methylene-tetrahydrofolate reductase gene and risk of venous thromboembolism

We evaluated the hypothesis that a common polymorphism of the methylenetetrahydrofolate reductase gene (C677T), which results in increased levels of plasma homocysteine, may be a putative risk factor for venous thromboembolism (VT). Sixty-five cases of VT and 130 controls, both identified within the framework of an epidemiologic survey on thrombophilia, the Vicenza Thrombophilia and Arteriosclerosis (VITA) Project, were genotyped for the mutation. No increased risk of VT was found in carriers of the mutation. We conclude that screening for the C677T mutation of the methylenetetrahydrofolate reductase gene should not be recommended in unselected patients with VT.     

Adjustment to a Newborn

Two groups of 20 mothers and their firstborn children (matched for age and sex) were investigated to determine whether sibling preparation for the birth of a newborn made a difference in the behavior of the children and in the mothers' perceptions of their own ability to cope with the children. One group of mothers and their children attended a sibling preparation class; the other group did not. Each group was pretested and posttested with the Parent-Child Assessment Tool. A significant difference was found between the two groups.     

Psoriatic arthritis and anti-nuclear factor

Positive tests for anti-nuclear factor were found in 7% of 101 patients with psoriatic arthritis. In only one case was this at a significantly high titre. The overall prevalence is that expected in the community, though there was a high prevalence in those with Sjögren's syndrome. This is a further differentiating feature from rheumatoid arthritis.     

Three Years of Cardiac Resynchronization Therapy: Could Superior Benefits be Obtained in Patients with Heart Failure and Narrow QRS?

Aim of the study: To examine the long-term effects of cardiac resynchronization therapy (CRT) in patients presenting with heart failure (HF) and QRS ≤120 ms.
Methods: This was a prospective, longitudinal study of 376 patients [mean age = 65 years, mean left ventricular (LV) ejection fraction (EF) = 29%, mean QRS duration =165 ms, mean distance covered during a 6-minute hall walk (6-MHW) = 325 m], who underwent successful implantation of CRT systems. The QRS duration at baseline was ≤120 ms in 45 patients (12%) who were not pre-selected by echocardiographic criteria of dyssynchrony, and >120 ms in the remaining 331 patients. The baseline characteristics of the 2 groups were similar. We evaluated indices of cardiac function, percentage of responders, and survival rates over a mean 28-month follow-up.
Results: Both groups experienced similar long-term increases in 6-MHW, and decreases in New York Heart Association functional class and LV end-systolic volume (all comparisons P < 0.0001 in both groups). Time interaction of changes in LVEF and percentage of responders were significantly different (P = 0.03 and P = 0.004, respectively), in favor of the narrow QRS group, where the changes were sustained and persisted at 2 and 3 years. The long-term death rate from HF was lower in the group with narrow than in the group with wide QRS complex (P = 0.04; log-rank test).
Conclusions: CRT confers considerable long-term clinical, functional, and survival benefits in patients presenting with HF and narrow QRS, not preselected by echocardiographic criteria of dyssynchrony. Caution is advised before denying CRT to these patients on the basis of QRS width only.