Ablation of left atrial flutter in a patient surgically treated for atrial fibrillation. Does it indicate a possible hybrid approach?

Surgical treatment of atrial fibrillation (AF) has a high success rate and nowadays simpler and faster procedures have been proposed. The following is a description of the case of a patient who, after a modified Maze procedure, developed an atypical left atrial flutter and underwent a successful radiofrequency ablation procedure. A 71-year-old male underwent surgical biological valve replacement and a concomitant modified Maze procedure.

Safety and efficacy evaluation of clopidogrel compared to ticlopidine after stent implantation: an updated meta-analysis.

Background: Combination therapy with aspirin plus ticlopidine has become the reference antithrombotic therapy after coronary stenting. However despite its effectiveness, ticlopidine is associated with a significant incidence of severe side effects. Thus, clopidogrel, a ticlopidine analogue with an excellent safety profile, has been introduced in clinical practice.

Association of cholesterol levels and occurrence of angiographically detectable endothelial disruption during coronary angioplasty.

Background: Disruption of the atherosclerotic plaque is a common feature of both acute coronary syndromes and balloon dilatation of coronary artery stenoses.

Hypothesis: The study was undertaken to evaluate whether the known association of cholesterol levels and acute coronary syndromes also exists for the occurrence of angiographically detectable endothelial disruption (ED) following coronary angioplasty.

Methods: For this purpose, we examined 79 consecutive patients (men/women 58/21; mean age: 62 +/- 11 years), with a noncalcified, de novo, significant stenosis in a single native coronary artery, undergoing elective coronary intervention because of stable effort angina.

Impact of intravascular ultrasound-guided stenting on long-term clinical outcome: a meta-analysis of available studies comparing intravascular ultrasound-guided and angiographically guided stenting.

To date, only a few studies have compared the clinical efficacy of intracoronary ultrasound (IVUS)-guided to angiographically guided stenting. Furthermore, it is not yet known whether the lower restenosis rate shown with the former strategy would translate into a substantial clinical advantage. Therefore, the aim of the present investigation was to improve the level of evidence of these studies by means of a formal meta-analysis.

[Relation between cardiology and cardiosurgery in a center without cardiosurgery: an organizational proposal in the coronary syndromes].

A modern cardiology department has very frequent relations with a heart surgery center for the management of stable and unstable patients with coronary artery disease. Therefore, these relations need to be formally defined. This impelling necessity stems from the clinical evidence that a high number of unstable patients need a timely revascularization as well as from the economical pressure to correctly allocate the limited surgical resources available.

Outcome of percutaneous coronary angioplasty (PTCA) performed in a low-volume institution by low-volume operators, evaluated by means of the one-month major adverse cardiac event rate.

Background: Since an inverse relationship between percutaneous coronary angioplasty (PTCA) case-load and in-hospital major adverse cardiac events (MACE) exists, we intended to evaluate the performance of low-volume PTCA operators, during the first year of our interventional program, by applying the more accurate index represented by the MACE rate within the first month.

Methods: The data relative to both the PTCA procedure and the control visit 3-4 weeks later, were retrospectively reviewed. Death, myocardial infarction and need for revascularization were the end-points evaluated, both globally and with respect to the individual operators.

Appropriateness of the use of coronary angiography in a population of patients with ischemic heart disease.

Background: Due to its pivotal role in the management of patients with ischemic heart disease, the use of coronary angiography has been continuously and progressively increasing over the years. However, an inappropriate rate of its utilization has been reported in 2 to 58% of cases. The aim of our study was therefore to evaluate the appropriateness of the indications for coronary angiography at our Institution.

Negative and positive predictive values of routine exercise testing in stable, medically-treated patients several years following a Q-wave myocardial infarction.

Background: Exercise testing (ET) is the preferred initial strategy for risk stratification after acute myocardial infarction (MI) in patients who are able to exercise and have an interpretable electrocardiogram (ECG). Although the current guidelines do not recommend annual follow-up ET of symptom-free patients years after MI, this is still common practice worldwide. Thus, this study was undertaken to explore the value of ET in the prediction of cardiac events in stable, medically-treated patients with a remote history of Q-wave MI.

[Initial experience with the use of abciximab in the salvage treatment of acute coronary thrombosis in the Hemodynamics Laboratory].

The optimal treatment of acute thrombotic complications in the Catheterization Laboratory has not been defined yet, due to the limited efficacy shown by various pharmacological regimens, even when associated to coronary angioplasty (PTCA). The aim of our study was therefore to evaluate the effects of abciximab (ReoPro), a new potent inhibitor of the platelet glycoprotein IIb/IIIa, when administered as a "rescue" treatment for acute thrombotic coronary occlusion during diagnostic or interventional procedures. Sixteen patients (12 males, 4 females, mean age 59.

Long-term prognosis of painless exercise-induced ischemia in stable patients with previous myocardial infarction.

Objectives: This study was designed to better understand the functional correlates and the prognostic relevance of exercise-induced painless ischemia relative to painful ischemia in patients with stable coronary artery disease and previous myocardial infarction (MI).

Background: The usefulness of exercise testing (ET) for predicting cardiac events, years after MI, although suggested and widely applied, is questionable. In particular, previous studies have reached conflicting conclusions as to whether exercise-induced painless ischemia is related to a less severe myocardial ischemia or to a different prognosis than painful ischemia.

Diagnostic approach to acute pulmonary embolism in a general hospital. A two-year analysis.

Background: Several approaches have been proposed for the diagnosis of acute pulmonary embolism (PE), but little is known about the strategies effectively used in daily clinical practice.

Methods: Retrospective evaluation of the diagnostic strategy used in our institution in the patients (pts) discharged between January 1st 1995 and December 31st 1996 with diagnostic code 415.1, corresponding to acute PE in the International Classification of Disease.

Can exercise testing in patients with a history of myocardial infarction predict fatal and non-fatal reinfarction?

Background And Objectives: Exercise testing (ET) is the preferred initial strategy for risk stratification in patients who are able to exercise and have an interpretable electrocardiogram. However, although it is often suggested and widely applied, its usefulness years after myocardial infarction (MI) is questionable. Therefore, this study was designed to assess the value of exercise testing in predicting the risk of fatal or non-fatal reinfarction in patients with chronic stable coronary artery disease (CAD) due to old myocardial infarction.

[Use of verapamil vs. beta blockers in patients with myocardial infarct. Retrospective evaluation of the yearly case load of a coronary care unit].

Background, Materials And Methods: To compare the relative use of verapamil and beta-blockers, which have shown comparable efficacy in reducing mortality and reinfarction rates in selected patients with myocardial infarction (MI), we retrospectively evaluated the ongoing treatment at the time of the pre-discharge evaluation in 221 consecutive patients (167 males and 54 females; mean age: 62.3 +/- 10.8 years) discharged alive in 1994 from our Hospital with the diagnosis of Q-wave MI.

[ST segment depression during recovery after treadmill exercise test in stable patients with previous myocardial infarction].

Background: The significance of exercise-induced ST segment depression is well known while limited data are available on the clinical/prognostic power of ST depression occurring only during recovery. Aim of the study was to clarify the clinical/prognostic value of "recovery only" ST depression in stable patients late from myocardial infarction (AMI) and to determine whether the addition of recovery data to exercise parameters improves the interpretation of exercise test.

Methods: From a population of 766 consecutive patients (mean age: 57.

Efficacy of long-term administration of transdermal nitroglycerin in asymptomatic patients with effort-induced silent myocardial ischemia.

The aim of our study was to investigate the effect of transdermal nitroglycerin (NTG) on effort-induced silent myocardial ischemia in asymptomatic patients treated with beta-blockers or calcium antagonists. The acute effect was compared to two different schedules, continuous (24 h/day) or intermittent (16 h/day), of long-term administration. Ten asymptomatic patients with coronary artery disease and a treadmill test positive for ischemia without angina were enrolled.

Comparative hemodynamic effects of intravenous digoxin and enoximone in severe chronic heart failure.

In order to compare the acute hemodynamic effects of digoxin (0.01 mg/kg) and enoximone (1 mg/kg), a phosphodiesterase inhibitor inotropic agent, in severe chronic congestive heart failure, 8 patients (male, mean age 56.7 years, sinus rhythm) were investigated with a randomized cross-over study.

Exercise-induced ventricular arrhythmias in patients with healed myocardial infarction.

Background: Controversy exists about the clinical and prognostic significance of exercise-induced ventricular arrhythmias late after myocardial infarction. The aim of the study was to identify the main clinical and prognostic features of exercise-induced ventricular arrhythmias in out-patients with healed Q-wave myocardial infarction.

Methods: The study population was 777 consecutive patients who underwent a symptom-limited (Bruce protocol) treadmill test from May 1988 to January 1991 after myocardial infarction (at least 1 year).

[The clinical and prognostic significance of symptomatic and silent ischemia on the exercise test in patients with a prior myocardial infarct].

The aim of the study was to assess clinical/prognostic significance of exercise-induced ischemia in patients with healed myocardial infarction. From May 1988 to January 1991, 777 consecutive patients underwent a symptom-limited (Bruce protocol) treadmill test at least 1 year after myocardial infarction. Clinical and ergometric data were entered in a prospective way in our data base.

Felodipine in chronic stable angina: a randomized, double-blind, placebo-controlled, crossover study.

To investigate the antianginal efficacy and tolerability of felodipine, a new dihydropyridine calcium antagonist, 20 patients with stable exertional angina, not completely controlled by beta-blocker monotherapy, entered a randomized, double-blind, placebo-controlled, crossover study. Patients on standard beta-blocker therapy, who had at least 3 weekly anginal episodes and a reproducible exercise test (stopped for angina and ECG signs of ischaemia) at the end of 2 weeks placebo treatment, were eligible for the study. They were randomized to one sequence of treatment: felodipine 5 mg twice daily for 2 weeks followed by placebo for a further 2 weeks, or vice versa.

A double-blind comparison of bisoprolol and captopril for treatment of essential hypertension in the elderly.

The aim of the study was to compare the antihypertensive efficacy and safety of a new beta blocker with high beta 1 selectivity, bisoprolol, with captopril in 28 elderly patients, aged over 65 years, with mild-to-moderate essential hypertension (WHO classes I and II). After a placebo run-in period of 4 weeks, the patients were randomly allocated to receive bisoprolol (5 mg od) or captopril (25 mg bid) (double-dummy technique) for 6 weeks, according to a crossover double-blind design, with a 4-week washout period between the two active treatments. The doses were doubled after 2 weeks if the supine blood pressure was greater than 160/95 mmHg.