Intérêt de la gamma-angiographie cardiaque pour l'identification des répondeurs et des non-répondeurs à la resynchronisation cardiaque biventriculaire

TOURS-BU Médecine (372612103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Antiarrhythmic Effect of Statin Therapy and Atrial Fibrillation A Meta-Analysis of Randomized Controlled Trials

ObjectivesTo improve the evaluation of the possible antiarrhythmic effect of statins, we performed a meta-analysis of randomized trials with statins on the end point of incidence or recurrence of atrial fibrillation (AF).BackgroundThe use of statins had been suggested to protect against AF in some clinical observational and experimental studies but has remained inadequately explored.MethodsA systematic review of controlled trials with statins was performed. Eligible studies had to have been randomized controlled parallel-design human trials with use of statins that collected data on incidence or recurrence of AF.ResultsSix studies with 3,557 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF undergoing electrical cardioversion (n = 2), and 3 investigated the use of statins in primary prevention of AF in patients undergoing cardiac surgery or after acute coronary syndrome. Incidence or recurrence of AF occurred in 386 patients. Overall, the use of statins was significantly associated with a decreased risk of AF compared with control (odds ratio [OR] 0.39, 95% confidence interval [CI] 0.18 to 0.85, p = 0.02). Benefit of statin therapy seemed more marked in secondary prevention of AF (OR 0.33, 95% CI 0.10 to 1.03, p = 0.06) than for new-onset or postoperative AF (OR 0.60, 95% CI 0.27 to 1.37, p = 0.23).ConclusionsUse of statins was significantly associated with a decreased risk of incidence or recurrence of AF in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery or after acute coronary syndrome

189 Similar implantable defibrillator event rates in patients with unexplained syncope and left ventricular dysfunction whatever the result of electrophysiological testing

ObjectivesThe purpose of this study was to evaluate the ventricular arrhythmias (VA) frequency in patients with unexplained syncope, ischemic or non-ischemic cardiac disease and left ventricular dysfunction (LVEF) and negative electrophysiological study (EP), implanted with cardioverter-defibrillator (ICD).BackgroundAccording to the current guidelines, EP is performed to evaluate syncope in patients with significant altered LVEF, mainly to guide treatment by ICD. Limited data concerning incidence of ventricular events in patients with no inducible arrhythmias is available.MethodsWe evaluated 58 consecutive patients with unexplained syncope who underwent EP. All patients had a depressed LVEF (< 45%). Sustained VA was only inducible in 28 patients (VF n = 8, SMVT n = 20). All patients were treated with ICD. We compared primary endpoint of severe VA in patients with negative and positive EP.ResultsBaseline characteristic were similar in the both groups. In the population (97% men), mean age was 67 ± 10 years, 67% had ischemic cardiopathy; mean LVEF was 30 ± 7% in non inducible group, 32 ± 9% in inducible group (p=0.16). During the follow-up (25 ± 22 months), 22 severe VA occurred; Kaplan-Meier analysis of time to first appropriate ICD therapy for non-inducible and inducible VA showed overlapping curves (p = 0.9), with 11 (37%) and 11 (39%) events in each group. Sub-group analysis according to LVEF and etiology of cardiopathy did not show significant difference.ConclusionsIn patients with unexplained syncope, ischemic or non-ischemic cardiopathy and left ventricular dysfunction, severe VA occurs in the follow-up at same rate whatever the result of EP. This study suggests that these patients should be treated with ICD without doing electrophysiological testing

Abstract 2864: Antiarrhythmic Effect of Statins and Atrial Fibrillation: A Meta-analysis of Randomized Controlled Trials.

The use of statins has been suggested to protect against atrial fibrillation (AF) in some clinical and experimental studies but remained inadequately explored. Specifically, observational studies provided evidence supporting a protective role of statins against atrial fibrillation. However, insufficient data are available at this time to allow recommendations for prevention of AF using statins. In order to improve the evaluation of their possible benefit, we performed a metaanalysis of randomized trials with statins on the endpoint of incidence or recurrence of atrial fibrillation. Methods. A systematic review of controlled trials with statins was performed. Data sources included Medline, Embase, Cochrane central register of controlled trials, and hand search. Predefined criteria were used to select controlled clinical trials. Eligible studies had to be randomized, controlled, parallel-design human trials with use of statins that collected data on incidence or recurrence of atrial fibrillation. Data were extracted for patients’ characteristics, interventions, quality of trials, and rates of events. Results. Four studies with 430 patients in sinus rhythm were included in the analysis. Three studies investigated the use of statins in patients with a history of paroxysmal AF (n = 1) or persistent AF after electrical cardioversion (n = 2) and one in primary prevention of AF in patients undergoing cardiac surgery. Coronary artery disease was present in 179/430 patients (42 %). Beta blockers were prescribed in 243/430 (57 %) and amiodarone in 7/430 (1.6 %) of the patients. Incidence or recurrence of atrial fibrillation occurred in 190 patients: 70/216 in patients treated with statin vs 120/214 in controls. Thus, the use of statins was significantly associated with a decreased risk of atrial fibrillation compared to control (relative risk 0.37, 95% confidence interval 0.25 to 0.55, p &lt; 0.0001). Conclusions. In randomized trials, use of statins in patients in sinus rhythm with a history of previous AF or undergoing cardiac surgery was significantly associated with a decreased risk of incidence or recurrence of atrial fibrillation. </jats:p

Incomplete recovery of mechanical and endocrine left atrial functions one month after electrical cardioversion for persistent atrial fibrillation: a pilot study

International audienceAbstract Background Restoration of the mechanical and endocrine functions of the left atrium remains controversial after electrical cardioversion treatment for persistent atrial fibrillation. The objective of the prospective study was to describe the recovery of the endocrine and mechanical functions of the left atrium. Methods Evaluation of left atrium recovery after electrical cardioversion by the new speckle-tracking echocardiography technique and proANP measurement. Results Twenty patients suffering from persistent atrial fibrillation with no alteration of left ventricular ejection fraction were prospectively evaluated at baseline and then one month later by echocardiography, measuring left atrial volume and left atrial deformation (MPALS), as well as the proANP and BNP concentrations. One month after cardioversion 10 patients remained in sinus rhythm and 10 showed recurrent atrial fibrillation. No significant differences between the two groups in terms of clinical, echocardiographic and endocrine parameters were observed at baseline evaluation. We observed a significant reduction of left atrial volume only in the sinus group, whereas restoration of the left atrial deformation was only partial (18%) in that group. By contrast, we registered no significant changes in ANP concentration at one month in either the sinus or the atrial fibrillation groups. Conclusion These results suggest that restoration of left atrium mechanical function is only partial one month after treatment of persistent atrial fibrillation by electrical cardioversion, whereas a significant reduction of left atrial volume was noted, explaining the remaining high level of ANP in the sinus group

Practical management of concomitant acute heart failure and worsening renal function in the emergency department

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Interventricular delay measurement using equilibrium radionuclide angiography before resynchronization therapy should be performed outside the area of segmental wall motion abnormalities

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