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The antiarrhythmic drug dronedarone was compared with placebo in 4628 patients with atrial fibrillation. At a mean follow-up of 21 months, the rate of first hospitalization due to cardiovascular events or death was significantly lower with dronedarone than with placebo. The dronedarone group had higher rates of bradycardia, QT-interval prolongation, nausea, diarrhea, rash, and increase in the serum creatinine level. The antiarrhythmic drug dronedarone was compared with placebo in patients with atrial fibrillation. At a mean follow-up of 21 months, the rate of first hospitalization due to cardiovascular events or death was significantly lower with dronedarone. Atrial fibrillation is the most common type of cardiac arrhythmia requiring medical care, with a prevalence of almost 1% in the adult population in the United States. 1 Its prevalence increases with age, affecting 3.8% of the U.S. population over 60 years of age and 9.0% of the population older than 80 years. Over the past two decades, hospitalizations for atrial fibrillation in the United States have increased by a factor of two to three, resulting in a substantial public health burden. 2 Despite advances in nonpharmacologic therapy, 3 many symptomatic patients receive medical treatment for rhythm control. Currently available antiarrhythmic agents are . . .

In two multicenter, randomized trials, the antiarrhythmic agent dronedarone was compared with placebo for the maintenance of sinus rhythm in patients with atrial fibrillation. With pooled data from the two trials, the median time to the recurrence of atrial fibrillation was 116 days in the dronedarone group and 53 days in the placebo group. With pooled data from two trials, the median time to the recurrence of atrial fibrillation was 116 days in the dronedarone group and 53 days in the placebo group. Atrial fibrillation is the most common arrhythmia requiring hospitalization. 1 , 2 Although arrhythmia-related symptoms and thromboembolic strokes are significantly reduced by anticoagulation therapy and rate control, sinus rhythm is often associated with improvement in exercise capacity and quality of life. 3 Therefore, restoration and maintenance of sinus rhythm remain major therapeutic goals for patients with atrial fibrillation. 3 – 6 Amiodarone is an especially potent atrial antifibrillatory agent, 7 but it induces potentially serious side effects in some patients. 7 – 10 Thus, compounds that are devoid of such effects but that retain the antiarrhythmic potential of amiodarone are therapeutically desirable. 7 , 11 Dronedarone is a benzofuran derivative . . .

In this multicenter, randomized trial comparing early rhythm control with usual care in patients with early atrial fibrillation and cardiovascular conditions, early rhythm control reduced the rate of death from cardiovascular causes and cardiovascular complications and did not affect the number of nights in the hospital.

Patients who had cardiac arrest without ST-segment elevation were assigned to undergo either immediate coronary angiography or delayed coronary angiography (after neurologic recovery). All patients underwent PCI if indicated. There was no significant between-group difference in overall survival at 90 days.

Abstract Aims Cardiac involvement in sarcoidosis is reported in up to 30% of patients. Left ventricular involvement demonstrated by contrast-enhanced cardiac magnetic resonance has been well validated. We sought to determine the prevalence and distribution of right ventricular late gadolinium enhancement in patients diagnosed with pulmonary sarcoidosis. Methods and results We prospectively evaluated 87 patients diagnosed with pulmonary sarcoidosis with contrast-enhanced cardiac magnetic resonance for right ventricular involvement. Pulmonary artery pressures were non-invasively evaluated with Doppler echocardiography. Patient characteristics were compared between the groups with and without right ventricular involvement, and right ventricular enhancement was correlated with pulmonary hypertension, ventricular mass, volume, and systolic function. Left ventricular late gadolinium enhancement was demonstrated in 30 patients (34%). Fourteen patients (16%) had right ventricular late gadolinium enhancement, with sole right ventricular enhancement in only two patients. The pattern of right ventricular enhancement consisted of right ventricular outflow tract enhancement in 1 patient, free wall enhancement in 8 patients, ventricular insertion point enhancement in 10 patients, and enhancement of the right side of the interventricular septum in 11 patients. Pulmonary arterial hypertension correlated with the presence of right ventricular enhancement (P < 0.001). Right ventricular enhancement correlated with systolic ventricular dysfunction (P < 0.001), hypertrophy (P = 0.001), and dilation (P < 0.001). Conclusions Right ventricular enhancement was present in 16% of patients diagnosed with pulmonary sarcoidosis and in 48% of patients with left ventricular enhancement. The presence of right ventricular enhancement correlated with pulmonary arterial hypertension, right ventricular systolic dysfunction, hypertrophy, and dilation.

This clinical trial of outcomes in patients with atrial fibrillation showed that lenient rate control (resting heart rate, <110 beats per minute) was not inferior to strict rate control (resting heart rate, <80 beats per minute). On the basis of the results, strict rate control may be abandoned as a therapeutic strategy in many patients with permanent atrial fibrillation. In patients with atrial fibrillation, lenient rate control (resting heart rate, <110 beats per minute) was not inferior to strict rate control (resting heart rate, <80 beats per minute). Atrial fibrillation is not a benign condition. 1 It may cause symptoms and is associated with stroke and heart failure. Previous studies have established that the rates of complications and death were similar in patients with atrial fibrillation receiving rate-control therapy and in those receiving rhythm-control therapy. 2 , 3 Therefore, rate control has become front-line therapy in the management of atrial fibrillation. The optimal level of heart-rate control, however, is unknown, as is whether strict rate control is associated with an improved prognosis as compared with a more lenient approach. 2 – 6 Guidelines, though empirical and not evidence-based, recommend the use of strict . . .

This study is the European counterpart of the North American study of atrial fibrillation reported in this issue of the Journal . Although the European study was smaller, the findings in the two studies were quite similar. Rate control was not inferior to rhythm control and should be regarded as appropriate for the management of persistent atrial fibrillation. Atrial fibrillation is not a benign condition. 1 , 2 For many clinicians, maintenance of sinus rhythm is the main therapeutic goal. In patients with persistent atrial fibrillation, repeated electrical cardioversion and prophylactic antiarrhythmic drugs are used to maintain sinus rhythm. 3 However, frequent recurrences of atrial fibrillation and adverse effects of drugs decrease the potential benefits of electrical cardioversion. 4 – 6 Also, the beneficial effects of rhythm control may be nullified by life-threatening cardiovascular events. Such events may be related not to the rhythm but, rather, to underlying cardiovascular abnormalities. 4 Since the rhythm is not the main determinant of the prognosis, it is . . .

The Euro Heart Survey showed that antithrombotic treatment in patients with atrial fibrillation (AF) was moderately tailored to the 2001 American College of Cardiology, American Heart Association, and European Society of Cardiology (ACC/AHA/ESC) guidelines for the management of AF. What consequences does guideline-deviant antithrombotic treatment have in daily practice? In the Euro Heart Survey on AF (2003-2004), an observational study on AF care in European cardiology practices, information was available on baseline stroke risk profile and antithrombotic drug treatment and on cardiovascular events during 1-year follow-up. Antithrombotic guideline adherence is assessed according to the 2001 ACC/AHA/ESC guidelines. Multivariable logistic regression was performed to assess the association of guideline deviance with adverse outcome. The effect of antithrombotic guideline deviance was analyzed exclusively in 3634 high-risk patients with AF because these composed the majority (89%) and because few cardiovascular events occurred in low-risk patients. Among high-risk patients, antithrombotic treatment was in agreement with the guidelines in 61% of patients, whereas 28% were undertreated and 11% overtreated. Compared to guideline adherence, undertreatment was associated with a higher chance of thromboembolism (odds ratio [OR], 1.97; 95% CI, 1.29-3.01; P = .004) and the combined end point of cardiovascular death, thromboembolism, or major bleeding (OR, 1.54; 95% CI, 1.14-2.10; P = .024). This increased risk was nonsignificant for the end point of stroke alone (OR, 1.42; 95% CI, 0.82-2.46; P = .170). Overtreatment was nonsignificantly associated with a higher risk for major bleeding (OR, 1.52; 95% CI, 0.76-3.02; P = .405). Antithrombotic undertreatment of high-risk patients with AF was associated with a worse cardiovascular prognosis during 1 year, whereas overtreatment was not associated with a higher chance for major bleeding.

Abstract Aims Cardiac involvement is the main determinant of poor outcomes in sarcoidosis. Right ventricular (RV) dysfunction and left ventricular (LV) late gadolinium enhancement (LGE) have been reported to be predictive of adverse outcome in non-ischaemic cardiomyopathies. The aim of our study was to determine whether delayed RV LGE with cardiovascular magnetic resonance would be predictive of adverse events in addition to LV LGE during the long-term follow-up of pulmonary sarcoidosis patients. Methods and results Eighty-four consecutive biopsy-proven pulmonary sarcoidosis patients were followed for a median of 56 months [38–74] after baseline delayed contrast-enhanced cardiac magnetic resonance. The composite primary endpoint consisted of admission for congestive heart failure, sustained ventricular tachycardia, appropriate implantable cardioverter defibrillator therapy, pacemaker implantation for high degree atrio-ventricular block, or cardiac death. The composite secondary endpoint included all-cause mortality in addition to the primary endpoint. RV and LV LGE were demonstrated in respectively 12 and 27 patients. Five of 10 events included in the primary endpoint occurred in the group with RV LGE. RV LGE, LV, or biventricular LGE yielded Cox hazard ratios of 8.71 [95% confidence interval (CI) 1.90–23.81], 9.22 (95% CI 1.96–43.45), and 12.09 (95% CI 3.43–42.68) for the composite primary endpoint. In a multivariate model, the predictive value of biventricular LGE for the composite primary and secondary endpoints was strongest. Kaplan–Meier event-free survival curves were most significant for RV LGE and biventricular LGE (log rank with P < 0.001). Conclusions Biventricular LGE at presentation is the strongest, independent predictor of adverse outcome during long-term follow-up. Asymptomatic myocardial scar <8% of LV mass carried a favourable long-term outcome.

BackgroundAdenosine can be used to reveal dormant pulmonary vein (PV) conduction after PV isolation (PVI). This study presents a subanalysis of real-world 1-year follow-up data from the ESC-EHRA EORP Atrial Fibrillation (AF) Ablation Long-Term registry to analyze the usage of adenosine during PVI treatment in terms of rhythm outcome and safety.MethodsThe registry consists of 104 participating centers in 27 countries within the European Society of Cardiology. The registry data was split into an adenosine group (AG) and no-adenosine group (NAG). Procedure characteristics and patient outcome were compared.ResultsAdenosine was administered in 10.8% of the 3591 PVI patients included in the registry. Spain, the Netherlands, and Italy included the majority of adenosine cases (48.8%). Adenosine was applied more often in combination with open irrigation radiofrequency (RF) energy (74.7%) and less often in combination with nonirrigated RF energy (1.6%). After 1 year, a higher percentage of the AG was free from AF compared with the NAG (68.9% vs 59.1%, p < 0.001). Adenosine was associated with better rhythm outcome in RF ablation procedures, but not in cryo-ablation procedures (freedom from AF: RF: AG: 70.9%, NAG: 58.1%, p < 0.001, cryo: AG: 63.9%, NAG: 63.8%, p = 0.991).ConclusionsThe use of adenosine was associated with a better rhythm outcome after 1 year follow-up and seems more useful in patients treated with RF energy compared with patients treated with cryo energy. Given the improved rhythm outcome at 1-year follow-up, it seems reasonable to encourage the use of adenosine during RF AF ablation.