Quinidine for Pharmacological Cardioversion of Long-lasting Atrial Fibrillation.

In the daily clinical practice, patients with atrial fibrillation (AF) lasting more than 48h (or not datable at all) are not uncommon. In long-lasting AF changes in electrophysiological features (electrical remodeling) can occur, resulting in a loss of sensibility to most antiarrhythmic drugs. There is strong evidence that the main mechanism involved in electrical remodeling is a global shortening in refractory period.

Carboplatin-induced Kounis syndrome.

A 50-year-old man in chemotherapy for an advanced lung adenocarcinoma presented with chest pain and cutaneous rash during carboplatin infusion with electrocardiographic (ECG) evidence of an inferior lesion wave. The administration of steroids and nitrates promptly resulted in clinical and ECG normalization, without enzymatic dismission. This reaction was considered compatible with allergic coronary vasospasm (also known as Kounis syndrome), a rare but possible complication of chemotherapy.